Comparative effectiveness of virtual versus in-person anaesthesiology consultations: the VIRTUAL retrospective cohort study.

Summary

This retrospective comparative-effectiveness study emulated a target trial among 17,027 adults with ASA physical status III or higher undergoing moderate- to high-risk elective noncardiac surgery. Noninferiority of virtual consultation for 90-day major morbidity or mortality was inconclusive, whereas length of stay, costs, and days alive and at home were noninferior, with lower carbon emissions associated with virtual care.

Key Findings

• Among 17,027 patients, the primary 90-day major morbidity or mortality outcome occurred in 26.3% after virtual consultation versus 24.9% after in-person consultation.
• Noninferiority for the primary outcome was inconclusive in both instrumental-variable and propensity-score analyses.
• Virtual consultation was noninferior for length of stay, costs, and days alive and at home, and was associated with reduced carbon emissions.

Clinical Implications

Virtual consultations may be appropriate for selected patients and healthcare pathways, particularly when access, travel burden, or sustainability is important. High-risk patients should not automatically be shifted to virtual assessment until triage criteria and additional safety data are established.

Limitations

• Retrospective observational design limits causal inference.
• The primary noninferiority conclusion remained inconclusive, and findings may depend on local telemedicine infrastructure and triage practices.

Future Directions

Future studies should prospectively evaluate risk-stratified triage algorithms, assess patient subgroups that require physical examination, and determine whether hybrid consultation pathways can preserve safety while maximizing access and environmental benefits.