Editor,

We read with interest the study by Jonker et al. entitled ‘Alternatives to the in-person anaesthetist-led preoperative assessment in adults undergoing low-risk or intermediate-risk surgery. A scoping review’.1 We congratulate the authors on this large-scale review comparing different alternatives to in-person preoperative visits regarding case cancellations, complications, financial burden or patient satisfaction. The authors argue, that regarding the outcome parameters mentioned above, a simple digital questionnaire represents an effective method for the preoperative assessment. Indeed, given the current financial and time constraints and limitations with outreach, such as during the recent global coronavirus disease 2019 (COVID-19) pandemic, it is important to consider alternatives to current standards of the preoperative evaluation. However, completely abandoning preoperative visits, may undermine important purposes of the preoperative appointments. We highlight three important considerations.

First, the conclusion of a superiority of a simple questionnaire is based on references. This warrants closer inspection: some of the studies assessing the questionnaire-based preoperative visit are dated and may be limited in the information about existent comorbidities. Additionally, some of the studies are based on surgical cohorts such as ophthalmology that involve patients with a lower surgical risk or exclude patients scheduled to undergo general anaesthesia. None of the older studies truly assessed patient satisfaction, one of the outcome parameters mentioned in Jonker et al.'s study.1

Second, as one of the cited studies in favour of the questionnaire-format from 1997 already stated, patient satisfaction needs to be assessed for sound evaluations of effectiveness and efficiency of preanaesthesia clinics.1

Conclusive studies assessing patient satisfaction with the preoperative evaluation process are currently lacking. Contrary to Jonker et al.'s results,1 telephone-based rather than questionnaire-based preoperative evaluations were preferred by patients in another large study.2

Third, apart from these discrepancies regarding alternative methods of preoperative assessment in current literature, insights on how to lead the preoperative conversations to achieve high patient satisfaction are missing. In fact, the most recent ‘guidelines for preoperative evaluation of patients undergoing noncardiac surgery’ still point towards the exact same open questions as in 1997, namely ‘What information is needed and/or wanted by the patient? How should this information be presented to the patient?’ as stated under the subsection of ‘how patients should be informed’.3

Patient satisfaction is an important outcome parameter consisting of different dimensions, among which information/involvement in decision-making and respect/confidence play a key role.4 Personal preferences, expectations and concerns such as anxiety and specific fears of surgery and anaesthesia need to be addressed at an early stage. In this regard, eHealth solutions are certainly not a ‘one size fits all’ approach, as was recently demonstrated in a study on chronic pain patients where acceptance of telemedicine negatively correlated with higher pain levels and anxiety.5 A similar effect may be seen in anaesthesiology. The ideal means to effectively transfer information while maintaining high patient satisfaction6 might be influenced by certain conditions such as pre-existing anaesthesia-related anxiety.7 Hence, the purpose of the preoperative visit should go beyond listing comorbidities and medications as the primary basis to inform decision-making on the anaesthesia methods. Instead, we believe it important to create a personal connection with the patient and tailor the conversation according to individual needs.8 Individual demands regarding information need to be clarified at the preoperative visit. Although legal requirements dictate a certain formal content for the preoperative discussion, an understanding of the demand for information represents an important determinant of success in restructuring preoperative visits.

To sum up, the preoperative visit offers a great opportunity to foster trust in the patient–physician relationship. Research assessing patient demands for the content of information rather than changing the form of the preoperative evaluation or even a complete abandonment of this extremely valuable chance to connect with patients is urgently required. It is our duty as responsible, caring perioperative physicians, to act as leaders on the path from ‘semper idem’ (Latin for ‘always the same’) towards tailored patient care.

Acknowledgements relating to this article

Assistance with the letter: none.

Conflicts of interest: none.

Financial disclosures: none.

This manuscript was handled by Tom Hansen.

References 1. Jonker P, van den Heuvel S, Hoeks S, et al. Alternatives to the in-person anaesthetist-led preoperative assessment in adults undergoing low-risk or intermediate-risk surgery: a scoping review. Eur J Anaesthesiol 2023; 40:343–355. 2. Lozada MJ, Nguyen JT, Abouleish A, et al. Patient preference for the preanesthesia evaluation: telephone versus in-office assessment. J Clin Anesth 2016; 31:145–148. 3. De Hert S, Staender S, Fritsch G, et al. Preoperative evaluation of adults undergoing elective noncardiac surgery: updated guideline from the European Society of Anaesthesiology. Eur J Anaesthesiol 2018; 35:407–465. 4. Heidegger T, Husemann Y, Nuebling M, et al. Patient satisfaction with anaesthesia care: development of a psychometric questionnaire and benchmarking among six hospitals in Switzerland and Austria. Br J Anaesth 2002; 89:863–872. 5. Harnik MA, Blättler L, Limacher A, et al. Telemedicine for chronic pain treatment during the COVID-19 pandemic: do pain intensity and anxiousness correlate with patient acceptance? Pain Pract 2021; 21:934–942. 6. Bello CM, Nuebling M, Koster KL, et al. Prevalence of patient-reported perioperative anxiety and its relation to patient satisfaction. Euroanaesthesia 2023; 17:4481. 7. Lin S-Y, Huang H-A, Lin S-C, et al. The effect of an anaesthetic patient information video on perioperative anxiety: a randomised study. Eur J Anaesthesiol 2016; 33:134–139. 8. Bello CM, Mackert S, Harnik MA, et al. Shared decision-making in acute pain services. Curr Pain Headache Rep 2023; 27:193–202.