Tackling anaesthesiology service bottlenecks and inefficiencies in preoperative care in Spain
Abstract
The demand for anaesthesia continues to grow, with procedures becoming more complex and involving higher-risk patients. Pre-anaesthesia evaluation (PREANE) is essential for risk stratification, optimisation and decision making, yet inadequate preparation often leads to the cancellation of elective surgeries. This study examined challenges in preoperative management within Spanish hospital anaesthesiology services, focusing on last-minute cancellations (LMCs), bottlenecks and hidden workforce burdens. Qualitative interviews were conducted with 18 heads of anaesthesiology departments to identify inefficiencies in perioperative care. The major issues found were staff shortages, inconsistent preoperative circuits and poor preparation (PPP), which sometimes led to surgeries performed under suboptimal conditions. Among hospitals reporting data, the average LMC rate due to PPP was 1.82 per cent, equating to nearly 66,600 cancelled procedures annually across Spain’s public health system. Cancellations most often stemmed from unreviewed preoperative recommendations and insufficient staffing for evaluations. Interviewees linked LMCs with hospital inefficiency and negative patient outcomes, including prolonged stays and higher complication rates. Findings revealed a 10 per cent deficit in anaesthesiology staff and frequent reliance on non-medical personnel for assessments. Most hospitals lacked key performance indicators (KPIs) to monitor suboptimal surgeries, although adverse outcomes could be inferred from increased intensive care use and lengthened hospitalisations. The study concludes that systematic data collection, standardised PRE-ANE pathways and better alignment of resources are essential. Integration of AI and machine learning into preoperative processes may further improve patient selection, reduce cancellations and strengthen departmental workflows. This analysis offers healthcare managers a reference framework to address inefficiencies and proposes actionable strategies for enhancing preoperative management in Spanish anaesthesiology services. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
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Author's Biography
Ancor Serrano-Afonso, MD, PhD, is a senior anaesthesiologist and leading researcher in pain management and perioperative care at Hospital Universitari de Bellvitge in Barcelona. Dr Afonso spearheads the Aiinane project, an innovative Class IIa AI platform that automates preoperative assessments by seamlessly integrating electronic health records, enhancing risk stratification, minimising last-minute surgical cancellations and optimising clinical workflows — successfully piloted in breast surgery and now expanding to ambulatory procedures across multiple specialities. Having completed his residency in Anaesthesiology and Reanimation (2002–2006) at Bellvitge, Dr Afonso directs the chronic pain clinic, with specialised expertise in neuropathic pain, complex regional pain syndrome and cutting-edge interventional therapies. He has served as principal investigator for numerous competitive grants, industry-sponsored trials and innovation initiatives at Bellvitge and IDIBELL, driving evidence-based advancements in perioperative medicine. His prolific research portfolio features dozens of peer-reviewed publications, garnering over 139 citations and an h-index of 4, with a focus on neuropathic pain mechanisms and anaesthesiology innovations. Dr Afonso’s integrated approach — merging clinical acumen, rigorous scholarship and AI technology — positions him at the forefront of transforming perioperative processes for superior patient safety and healthcare efficiency.
Carlos Jiménez-Padilla, MD, is a dedicated specialist in Anaesthesiology, Resuscitation and Pain Therapeutics at Hospital Universitari de Bellvitge, Barcelona, bringing a robust background in paediatric critical care from his prior role as a medical specialist in paediatrics and specific areas. Dr Padilla’s career emphasises comprehensive critical care across high-acuity settings, complemented by extensive teaching contributions to courses organised by the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR). Actively engaged in cutting-edge research, he advances AI applications in preoperative medicine and hospital process automation, including contributions to the Aiinane project for streamlined assessments and reduced inefficiencies. Since his residency, Dr Padilla has championed biostatistics and data science, making these tools accessible to healthcare professionals through education and practical implementation, as evidenced by his involvement in AI health intelligence courses and working groups like SEDAR’s Vascular Access team. He holds a master’s in adult advanced life support from Universitat Autònoma de Barcelona (Bellvitge) and pursues innovative haemodynamic research, such as meta-analyses on goal-directed therapy in abdominal surgery. Dr Padilla’s blend of clinical expertise, pedagogical impact and data-driven innovation positions him as an important figure in modernising anaesthesiology for enhanced patient care and operational excellence.
Roger Añor-Grasa is a computer science engineer (MSc candidate in data science, Universitat de Barcelona) specialising in full-stack development and AI-driven digital solutions for health care. As CTO and lead full-stack engineer at Aiinane — a pioneering SaaS platform for automating preoperative assessments in anaesthesiology — Mr Grasa oversees the entire development life cycle, from conceptualisation and architecture to implementation and refinement. Leveraging symbolic AI, Mr Grasa cross-references patient questionnaires with electronic health records to deliver precise risk evaluations, slashing last-minute surgical cancellations, minimising redundant tests, optimising operating room utilisation and enhancing patient experience. Concurrently, he serves as a software engineer at Institut Català de la Salut, designing a digital coordination system for organ procurement and transplantation teams, streamlining real-time communication, data exchange and logistics in critical procedures. As part of his affiliation with Hospital Universitari de Bellvitge’s innovation ecosystem and simulation centre, he contributes to IDIBELL-linked projects in perisurgical research. With expertise in scalable cloud-based systems and health informatics, Añor applies his contributions to empower data-informed decisions, bridging engineering innovation and clinical needs to foster efficient, patient-centred healthcare transformation.
Professor Maria J. Colomina, MD, PhD, is Head of the Anesthesia, Resuscitation and Pain Management Department at Bellvitge University Hospital (Barcelona) and Full Professor of Anaesthesiology in the Department of Clinical Sciences at the University of Barcelona (Bellvitge Campus). A distinguished specialist in perioperative medicine, Prof. Maria excels in patient blood management (PBM), haemostasis, transfusion medicine and the care of complex surgical patients, including those in neurosciences and high-risk procedures. She leads the Neurosciences — Perioperative Pathophysiology and Pain Research Group at IDIBELL, spearheading studies on neural impacts of anaesthesia, postoperative cognitive dysfunction and chronic pain pathways. As Vice President of the Spanish Society of Anaesthesiology, Resuscitation, and Pain Therapy (SEDAR) — specifically Vice President Second — she shapes national guidelines, chairs working groups on haemostasis and transfusion and contributes to events like Campus SEDAR. Prof. Maria integrates clinical leadership, academia and research to advance patient safety, optimise resource use and promote evidence-based innovations in anaesthesiology.
Citation
Serrano-Afonso, Ancor, Jiménez-Padilla, Carlos, Añor-Grasa, Roger and Colomina, Maria J. (2026, September 1). Tackling anaesthesiology service bottlenecks and inefficiencies in preoperative care in Spain. In the Management in Healthcare: A Peer-Reviewed Journal, Volume 11, Issue 1. https://doi.org/10.69554/DSBI4482.
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