Postdischarge Virtual Visits for Low-risk Surgeries

Abstract

video-based virtual visits are a growing aspect of surgical care and have dramatically increased in the setting of the coronavirus disease 2019 (COVID-19) pandemic.OBJECTIVE To evaluate the outcomes of all-cause 30-day hospital encounter proportion among patients who have a postdischarge video-based virtual visit follow-up compared with in-person follow-up.DESIGN, SETTING, AND PARTICIPANTS Randomized, active, controlled noninferiority trial in an urban setting, including patients from a small community hospital and a large, tertiary care hospital. Patients who underwent minimally invasive appendectomy or cholecystectomy by a group of surgeons who cover emergency general surgery at these 2 hospitals were included. Patients undergoing elective and nonelective procedures were included.INTERVENTIONS Patients were randomized in a 2:1 fashion to video-based virtual visit or in-person visit. MAIN OUTCOMES AND MEASURESThe primary outcome is the percentage of patients with 30-day hospital encounter, and we hypothesized that there would not be a significant increase in the 30-day hospital encounter proportion for patients who receive video-based virtual postdischarge care compared with patients who receive standard (in-person) care. Hospital encounter includes emergency department visit, observation, or inpatient admission.RESULTS A total of 1645 patients were screened; 289 patients were randomized to the virtual group and 143 to the in-person group. Fifty-three patients crossed over to the in-person follow-up group. The percentage of patients who had a hospital encounter was noninferior for virtual visits (12.8% vs 13.3% for in-person, Δ 0.5% with 1-sided 95% CI, −ϱ to 5.2%). The amount of time patients spent with the clinician (mean of 8.4 minutes virtual vs 7.8 minutes in-person; P = .30) was not different, but the median overall postoperative visit time was 27.5 minutes shorter (95% CI, −33.5 to −24.0). CONCLUSIONS AND RELEVANCEPostdischarge video-based virtual visits did not increase hospital encounter proportions and provided shorter overall time commitment but equal time with the surgical team member. This information will help surgeons and patients feel more confident in using video-based virtual visits.

Telemedicine implementation trends in surgical specialties before and after COVID-19 shelter in place: Adjusting to a changing landscape

“…We were not able to measure outcomes. However, in a randomized trial comparing video based or in-person postoperative visits for laparoscopic appendectomy or laparoscopic cholecystectomy, the primary outcome of a 30-day hospital encounter was noninferior ( 36 ). In a larger narrative review of the use of telemedicine in surgical clinics, seven studies showed no statistical difference in complication rates for low-risk surgical patients who had an in-person follow-up compared to telemedicine visit ( 37 ).…”

In-Person Versus Video Preoperative Visit: A Randomized Clinical Trial

“…In addition, no operative delays were noted in these telehealth-evaluated patients on the day of surgery 3 . Several general surgery and urology studies have demonstrated that telehealth postoperative visits are safe, efficient, and improve patient satisfaction 4–8 …”

“…2 Telehealth communication technology has been shown as a feasible modality for perioperative care in multiple surgical fields. [3][4][5][6][7][8] Patients report no difference in satisfaction when telehealth is used for preoperative anesthesia evaluations compared with in-person evaluation. 3 In addition, no operative delays were noted in these telehealth-evaluated patients on the day of surgery.…”

“…3 Several general surgery and urology studies have demonstrated that telehealth postoperative visits are safe, efficient, and improve patient satisfaction. [4][5][6][7][8] Patients presenting to female pelvic medicine and reconstructive surgery (FPMRS) clinics are excellent candidates for telehealth visits because they often have internet access and a desire to learn about their conditions outside of the office setting through websites and social media. 9,10 A recent randomized controlled trial revealed that telephone calls for postoperative follow-up after surgical management of pelvic floor disorders resulted in noninferior patient satisfaction without differences in clinical outcomes or adverse events.…”

“…The Health Resources and Services Administration of the U.S. Department of Health and Human Services defines telehealth as the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health, and health administration 2 . Telehealth communication technology has been shown as a feasible modality for perioperative care in multiple surgical fields 3–8 . Patients report no difference in satisfaction when telehealth is used for preoperative anesthesia evaluations compared with in-person evaluation 3 .…”