A Randomized Controlled Trial Comparing pre-anesthesia Evaluation via Telemedicine to In-Person at an NCI-Designated Comprehensive Cancer Center

Introduction: To compare in-person pre-anesthesia evaluation (PAE) to virtual evaluation at home using a remote stethoscope. Methods: One hundred and six (N =106) presurgical hysterectomy and prostatectomy patients were approached to be enrolled in the study: 53 from each surgical group. Those who agreed were then randomized using random allocation codes to in-person versus telemedicine with Eko DuoTM stethoscope versus PAE. Results: In 39/49 patients, the Eko allowed remote auscultation of heart sounds and electrocardiogram tracing. Airway exam concordance was 62% for in-person and 65% for virtual patients compared with the day of surgery (DOS) exam (p = 0.796). The mean clinic visit time was 89.5 ± 104.5 versus 110.4 ± 24.1 min for telemedicine and in-person cohorts (p < 0.001). Telemedicine patients saved mean roundtrip driving distance and time of 124.58 ± 81.40 miles and 124.58 ± 74.72 min, respectively, with $103.67 ± 78.80 in cost savings ($0.82/mile) and 43.22 ± 33.45 kilograms fewer carbon dioxide emissions per patient. Conclusions: Telemedicine PAE saves time, distance, and costs, and does not seem to be associated with increased DOS cancellations. Virtual visits were shorter and scheduled sooner. The remote stethoscope showed high concordance to in-person exam. Patients were highly satisfied, indicating they would undergoanother telemedicine visit with digital stethoscope.