Impact of Heart Disease History on Safety of Telemedicine Cardiac Clearance Appointments

Abstract

Purpose:The objective of this study was to compare complication, readmission, mortality, and cancellation rates between patients who had either an in-person or telemedicine preoperative cardiac clearance visit before spine surgery.Methods:A retrospective review was conducted on patients who underwent a spine procedure at a single tertiary academic center from February 1, 2020, to June 30, 2021. Cancellations, inpatient complications, 90-day readmissions, and inpatient and 90-day mortality rates were compared between in-person and telemedicine cardiac clearance visits. Secondary analysis included multiple logistic regression to determine independent predictors of case cancellations and complications. Alpha was set at P < 0.05.Results:A total of 1,331 consecutive patients were included, with 775 patients (58.2%) having an in-person cardiac clearance visit and 556 (41.8%) having telemedicine clearance. Overall, the telemedicine cohort did not have more cancellations, complications, or readmissions. Regardless of the type of clearance, patients with a history of cardiac disease had more inpatient complications (15.8% versus 6.9%, P < 0.001) and higher 90-day mortality rates (2.3% versus 0.4%, P = 0.005). Subgroup analysis of patients with a history of cardiac disease showed that patients who had telemedicine visits had more cancellations (4.6% versus 10.9%, P = 0.036) and higher 90-day mortality rates (1.4% versus 4.4%, P = 0.045). On regression analysis, telemedicine visits were not independent predictors of preoperative cancellation rates (P = 0.173) but did predict greater preoperative cancellations among patients with cardiac history (odds ratio 2.73, P = 0.036).Discussion:Patients with cardiac disease who undergo preoperative telemedicine visits have greater preoperative surgical cancellation rates and postoperative 90-day mortality rates. Although preoperative telemedicine visits may be appropriate for most patients, a history of cardiac disease should be a contraindication.

Assessment of a Private Payer Bundled Payment Model for Lumbar Decompression Surgery

“…On assessing whether the episode of care was associated with a surplus or deficit, we similarly identified that a history of heart disease and venous thromboembolic events were more likely to predict a loss. Given that cardiovascular conditions, including heart failure and heart disease, have been associated with increased healthcare costs because of greater postoperative complications and readmissions after lumbar spine surgery, 20-22 preoperative cardiac evaluation and medical optimization may reduce resource utilization after lumbar decompression and lumbar fusion care episodes. Interestingly, increasing age and diagnoses of chronic lung disease and arrhythmia were associated with a greater surplus.…”

Effectiveness of telehealth versus in-person care during the COVID-19 pandemic: a systematic review

“…We identified 7 mostly small observational studies 16,27,35,39,[56][57][58][59] . Studies reported a variety of adverse events across 4 of the clinical areas (Fig.…”

“…3C, Supplementary Table 8 -Bottom Tier, and Supplementary Fig. 1C) 28,31,43,45,52,[59][60][61][62][63][64][65][66][67][68] . For general medical care among adults (N = 2 studies) telehealth resulted in a higher rate of missed visits.…”