Anesthesia TeleConsultation for Pediatric preoperative assessment: a large national prospective multicentric study in children (TeleCCCAP)

Abstract

Background: While interest in pediatric anesthesia teleconsultation is growing, published data remain scarce. This study evaluated the feasibility of anesthesia teleconsultation in children, providing a comprehensive analysis of failure, quality, dedicated time and satisfaction. Methods: This prospective observational study was performed in 11 major French hospitals. The primary outcome was anesthesia teleconsultation feasibility. Feasibility was defined as the rate of successful anesthesia teleconsultations, i.e . those performed in presence of both child and parent, exclusively via the dedicated secure audiovisual platform, and not requiring a complementary in-person appointment. Secondary outcomes included: causes and consequences of failure; factors associated with failure; quality of anesthetic preparation, medical time dedicated to preoperative assessment; analysis of parents and anesthetist satisfaction. Results: A total of 830 children aged 6.7 [3.5-12.2] years were included. Feasibility of anesthesia teleconsultation was 73%. Failure was due to technical (91%), organizational (9%), and medical (1%) issues. Three anesthesia teleconsultations (0.4%) were converted to in-person consultations. Factors associated with technical failure included the use of tablets or smartphones rather than computers ((OR, 95%CI): 2.44, 1.40 to 4.26, p=0.002), the absence of a pre-connection test ((OR, 95%CI): 6.21, 3.05 to 12.66, p<0.001) and several sociodemographic characteristics. On the day of surgery, no procedure was cancelled, one was postponed, one anesthetic strategy was modified. Medical time dedicated to preoperative evaluation was 28 [18,33] minutes. Parental satisfaction was high, 93% would choose teleconsultation for a future procedure. Anesthetist’s satisfaction was high: 96% with medical aspects, 90% with the suitability for the case, 72% with the quality of information delivered. Technical failure consistently impacted all components of anesthetist satisfaction. Conclusion: This national audit highlights that addressing technical and organizational issues appears essential to transform anesthesia teleconsultations from a mere tool into a robust clinical process, ensuring its reliability and clinical utility in pediatric anesthesia.