Background: In Germany, over 16 million pre-anesthesia consultations (PAC) are conducted annually, which is associated with a significant investment of time and high costs. However, some PACs do not lead to surgery, which is inefficient and results in wasted resources. This study evaluates the costs and time loss associated with PACs that did not result in anesthesia-required surgery or diagnostic procedures and identifies the predictors of these cancellations. Methods: A total of 1357 PACs conducted in September 2023 at the University Hospital Aachen were retrospectively analyzed. The study groups included patients whose PACs resulted in anesthesia-required surgery or diagnostic procedures (SURG group) and those whose PACs did not (NoSURG group). The primary outcomes were costs in EUR and the hours lost due to PACs not resulting in anesthesia for patients in the NoSURG group, and the secondary outcomes included the predictors of surgery cancellations, the frequency of missing test results, necessary pre-anesthesia re-consultations due to missing tests, and hospital length of stay for NoSURG patients. Results: In September 2023, 7.3% (99/1357) of PACs did not result in anesthesia-required procedures. ASA scores were higher in the NoSURG group, with almost two-thirds classified as ASA III or higher (p = 0.001). The NoSURG group had more planned postoperative IMC stays (16.2% vs. 9.3%; p = 0.027) and fewer medical report letters available (50.5% vs. 97.1%; p < 0.001). The reasons for surgery cancellation were often undetermined (47.5%). Other reasons included surgeons opting for a conservative approach (19.2%), patient decisions (9.1%), surgery no longer indicated (8.1%), hospital capacity constraints (5.1%), patient transfers (3.0%), and high surgical risk (8.1%). The annual projected cost for the NoSURG group was EUR 29,182, with 888 h of time loss. The median hospital length of stay for the NoSURG group was 5 (2; 15) days. Conclusions: PACs that were carried out but were not followed by anesthesiology services led to substantial costs and time loss. Improving medical report availability and assessing procedure necessity beforehand might help to reduce these expenses and time losses.

Background: The venous-to-arterial difference in partial pressure of carbon dioxide (CO2 gap) has been suggested as a marker of cardiac output and clinical outcomes. This study aimed to evaluate the CO2 gap as a prognostic indicator for 28-day survival in patients undergoing transcatheter aortic valve replacement (TAVR) and to explore its relationship with cardiac function and lactate levels. Methods: In this prospective cohort study, 50 TAVR patients were stratified based on their left ventricular ejection fraction (LV-EF) and survival status. Central venous and arterial blood samples were collected at five time points to measure blood gas parameters. The primary endpoint was the prognostic value of the CO2 gap for 28-day survival. Secondary endpoints included group differences in the CO2 gap, its correlation with lactate levels, and CO2 content analysis. Results: ROC analysis indicated limited prognostic value for 28-day survival. The CO2 gap was higher in non-survivors than in survivors (11.1 mmHg vs. 6.8 mmHg, p = 0.039), but showed no significant difference between individual time points. The CO2 gap between cardiac (LV-EF ≤ 50%) and non-cardiac (LV-EF > 50%) groups showed no significant difference. Lactate and CO2 gap showed no correlation, except at T2 in the cardiac group (p = 0.039, r = 0.525). CO2 content showed no significance, except at T5, where it was significantly higher in survivors (5.3 mL/dL vs. 1.1 mL/dL, p = 0.003). Conclusions: The CO2 gap did not emerge as a reliable prognostic marker for 28-day survival in TAVR patients. Further studies are needed to explore its clinical relevance.

Background/Objectives: Pre-anesthetic consultations (PACs), conducted by anesthesiologists, are an established procedure to assess individual perioperative risk in surgical patients. Cancellation of surgery leads to unnecessary PACs, which have to be avoided in times of staff shortage. The aim of the study is to evaluate the costs and time loss of unnecessary PACs at Hannover Medical School, a university hospital in Germany. Methods: All PACs conducted at Hannover Medical School in September 2023 were included in the analysis. The duration and associated costs were calculated based on electronic documentation. Results were compared to data from the university hospital Aachen in Germany. Results: In 4.2% of all PACs, no surgical or interventional procedure was subsequently performed and therefore no anesthesiologic services were required. Reasons for surgery or intervention cancellation included choosing a conservative approach over surgery or proceeding with surgery under local anesthesia without the presence of an anesthesiologist. The additional costs for unnecessary PACs were EUR 1612 which corresponded to 43.2 h of working time. Projected over a year, this would result in EUR 19,344 in costs and 518.4 h of time spent. In comparison to university hospital Aachen, we observed lower cancellation rates after PACs and a greater reliability of the planned interventions and surgeries. Conclusions: The results of this study suggest that the financial and time burden associated with these consultations was not substantial. To ensure optimal use of temporal and financial anesthesiologic resources, it is essential to avoid PACs for patients who will not undergo surgery or intervention.