The Impact of a Pre-anesthesia Clinic on Operating Room Utilization, Patient Safety Outcomes and Patient Satisfaction: A Prospective Cohort Study in Two Tertiary Hospitals in Addis Ababa, Ethiopia

Abstract

Abstract Background: In Ethiopia, high surgical cancellation rates, prolonged operating room (OR) times and frequent perioperative complications are common. Inadequate preoperative assessments, undiagnosed comorbidities and systemic issues are the main drivers of these challenges. However, there is no local data on the implementation of preanesthesia clinic (PAC) on operating room utilization, patient safety outcomes and Patient Satisfaction in Ethiopia. Objective: To evaluate the impact of a PAC on OR utilization, patient safety outcomes and Patient Satisfaction among adult elective surgical patients at St. Paul’s Hospital Millennium Medical College (with PAC) compared to Addis Ababa Burn, Emergency, and Trauma Hospital (without PAC). Methods: This prospective cohort study compared adult patients undergoing moderate to complexity elective surgery (lasting 45 – 240 minutes under general/regional anesthesia) at SPHMMC and AaBET. A sample of 544 patients (272 per hospital) was calculated to detect differences in day of surgery cancellation rate, anesthesia controlled time and perioperative complication rate and patient satisfaction between AaBET and SPHMMC with 80% power, 5% significance, and 10% attrition. Consecutive sampling was used to enroll patients and data collected through operating room time log or cancelations, medical record review for complications, and structured patient interviews using a validated preoperative patient satisfaction questionnaire adapted to the local contex.. Multivariable regression analysis was used to adjust for differences in department case mix and patient characteristics. Results: The day of surgery cancellation was lower at SPHMMC (11.8%) compared to AaBET (16.5%). After multivariable adjustment, this difference was not statistically significant (AOR = 0.94; 95% CI: 0.25 to 3.54; p = 0.921), with the wide confidence interval reflecting residual confounding and limited precision. Mean anesthesia controlled time was 12.48 minutes at SPHMMC compared to 12.69 minutes at AaBET, with no significant association in multivariable analysis (β = 0.352; 95% CI: −0.568 to 1.272; p = 0.452). Perioperative complications assessed during the first 3 days after surgery (while patients are still hospitalized) occurred in 1.3% of patients at SPHMMC and 0.9% at AaBET, a difference that was not statistically significant (RR = 1.42; 95% CI: 0.24–8.60; p = 1.00, Fishers exact test) with complete follow up. Patient satisfaction scores were nearly similar between groups (3.30 vs 3.28), but PAC attendance was not associated with patient satisfaction (β = −0.043; 95% CI: −0.436 to 0.349; p = 0.829). Conclusion: The presence of a preanesthesia clinic was not independently associated with improved operating room efficiency, perioperative safety, or patient satisfaction in this study. These findings suggesting further large scale studies to confirm the finding. Keywords: Preanesthesia clinic, Operating room efficiency, Perioperative complications, cancellation, Ethiopia