O3
O3
PINEAPPLE: PaedIatric caNcellation ratEs And PerioPerative clinicaL Evaluation
C. L. Riley1, T. Bennett2, H. Lewis3
1Sheffield Children's Hospital, Barnsley, UK
2University Hospital Southampton, UK
3Evelina Children's Hospital, London, UK
Introduction and aims
Paediatric pre-operative assessment (P-POA) is an emerging field with the potential to improve outcomes from paediatric surgery.
Best practice P-POA standards are published (1) and it is recommended that “children undergoing anaesthesia should be offered a preadmission pre-assessment service” (2).
PINEAPPLE is a multicentre, prospective observational cohort study.
The primary aims were to:
- establish the proportion of children 16 years old and under seen in P-POA clinic prior to an elective procedure under general anaesthetic (GA)
- establish the format of that pre-assessment
The secondary aims were to:
- establish the on the day cancellation rate for children presenting for surgery and reason for cancellation
- establish the incidence and impact of anxiety
Methods
Invitations were sent to members of the Paediatric Anaesthetic Trainee Research Network (PATRN) and the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI). 98 hospitals enrolled and registered the study with their local governance team. The HRA tool determined that this study is a nationally coordinated, locally conducted audit therefore ethical approval and patient consent were not required.
Data collection
Recruitment occurred prospectively between April and June 2023 over a 14-day period. All patients ≤ 16 years of age undergoing an elective procedure under GA were included. The anaesthetist for each list completed a case report form for each patient which was anonymised and uploaded to the electronic database.
Each centre also completed a questionnaire about their delivery of P-POA.
Exclusion criteria
Children undergoing emergency or repeated procedures under GA were excluded from the study. Sedation or local anaesthetic cases were also excluded.
Results
The survey found that 80/98 centres (82%) have a P-POA service; 84% of those were nurse-led.
7286 cases were recorded. 4390 patients (59%) had P-POA, most commonly by telephone appointment. 3375 (76%) of those pre-assessed did not need anaesthetic consultant involvement. When this was needed, 503 cases (49%) were resolved with notes review only.
In children seen in P-POA, 15% had management altered; this was most commonly a clinical decision such as bed allocation.
There was no significant difference in on-the-day cancellations between children who had and had not been seen in P-POA; the cancellation rate for each was ~4%. However, a child has a 9% chance of a change on the day without POA (i.e. not proceeding as planned). This reduces to 7% with POA (p<0.05).
Anxiety was an issue preoperatively in 17% of children having an anaesthetic. This was reduced to 12% if the child had POA (p<0.05).
Discussion and Conclusion
Most UK hospitals offer some form of paediatric pre-operative assessment. This study suggests that this is likely to improve theatre efficiency as well as patient experience and perioperative anxiety. Further statistical analysis of these data are ongoing.
References
- APAGBI Best Practice Pre-assessment Standards in Children https://www.apagbi.org.uk/sites/default/files/2022-05/Best%20Practice_Pre-assessment%20standards%20in%20Children%20%202022%20-%20Published.pdf Accessed 30/01/2024
- Royal College of Anaesthetists Guidelines for the Provision of Anaesthetic Services (GPAS) Chapter 10: Guidelines for the Provision of Paediatric Anaesthesia Services 2024 https://www.rcoa.ac.uk/gpas/chapter-10 Accessed 30/01/2024