Prospective and retrospective study of videoconference telemedicine follow-up after elective neurosurgery: results of a pilot program

Abstract

Existing literature suggests that use of telemedicine during postoperative appointments can increase access to care and is valued by patients and providers alike. While research examining the clinical equivalency of telemedicine visits for postoperative care has been growing, few studies have reported on telemedicine follow-up after neurosurgery. This study examined if a videoconferencing visit could substitute for an in-person clinic visit for elective neurosurgical cases in the USA. This was a single-center prospective study of patients who underwent elective neurosurgical procedures (aneurysm clipping, resection of cavernous angiomas, resection of arterial venous malformation, microvascular decompression for trigeminal neuralgia and hemifacial spasm, and certain benign brain tumors) and were offered telemedicine follow-up care by an allied health professional during the first 90 days after neurosurgery. Prospective data was compared to a historical group of patients who underwent the same procedures and received in-person postoperative follow-up. Patients in the prospective group were contacted by telephone 2-6 weeks after surgery by a nurse practitioner and assessed using a standard template that included incidence of reported postoperative seizures, fever, and performance of activities of daily living. Primary outcome measures included percentage of patients accepting telemedicine, clinical and functional status, complications, patient satisfaction, patient travel time and distance, and rates of emergency room care or hospitalization within 90 days of discharge. Ninety-nine patients were included in the study, with 57 in the prospective group and 42 in the historical group. Of the 57 prospective patients, 47 accepted telemedicine in lieu of an in-person clinic visit. Emergency room visits and readmission rates at 30 and 90 days postoperatively did not differ significantly between the study groups, nor was there any significant difference in clinical variables that were recorded in the electronic medical record more than 80% of the time. This study demonstrates the safety and value of telemedicine as an alternative method of postoperative clinical care for patients undergoing elective neurosurgery. Telemedicine avoids unnecessary travel time and was welcomed by the majority of patients without compromising clinical or functional outcomes.

Expanding The Use of Telemedicine in Neurology: A Pilot Study

“…Telemedicine is an increasingly viable, cost-effective, convenient alternative to traditional neurological care delivery, enabling providers to connect with patients and consultants across distances (Reider-Demer, 2017). This pilot study supports telemedicine as an option for neurological patients with favorable patient/provider satisfaction.…”

“…Although total costs were not assessed, some specific cost savings were noted throughout the feasibility study. Typically, patients and families that drove to and from the medical center often missed work (Reider-Demer, 2017). Costs for fuel in the state of California averaged $0.54/mile.…”

“…Traditional ways of providing health care are constantly being improved as evidenced by the increasing use of telemedicine. This option enables providers to connect with patients and consultants across challenging geographic distances in a cost-effective, convenient manner (Reider-Demer, 2017). In neurology and neurosurgery populations, telemedicine in various formsfrom store-and-forward technology to real-time videoconferencing-has demonstrated good outcomes.…”

Letter: Academic Neurosurgery Department Response to COVID-19 Pandemic: The University of Miami/Jackson Memorial Hospital Model

“…These visits have been replaced by telemedicine clinic visits, which have previously been validated in the neurosurgery population. [5][6][7][8][9] We have implemented Health Insurance Portability and Accountability Act (HIPPA)-compliant telehealth technology integrated into our electronic medical record (Epic, Epic Systems Corporation, Verona, Wisconsin). Neurosurgeons and their patients can communicate via secure video-conference feed using a computer, mobile device, or tablet.…”

Editorial. Telemedicine for elective neurosurgical routine follow-up care: a promising patient-centered and cost-effective alternative to in-person clinic visits

“…10 Relatively brief, structured telemedicine visits for some post-neurosurgical follow-up care can reduce the time and travel costs to patients and their families, and they can reduce stress. 8 Systematic review evidence of telemedicine intervention outcomes for postsurgical follow-up care comes from 21 mostly small US studies subject to selection bias in diverse low-risk surgery patients published between 2010 and July 2015. 3 For the included studies that reported the following outcomes, the majority of patients were willing to use telemedicine, and there was high patient and provider satisfaction, and universal and significant savings in round-trip travel distance, time, and costs.…”