Telemedicine may improve access to quality care, ‘narrow disparities’ in bariatric surgery
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Clinical outcomes at 30 and 60 days and postoperative hospital utilization were similar among patients who received fully remote vs. in-person preoperative care for bariatric surgery, according to results in JAMA Network Open.
“Telemedicine use has grown dramatically since the beginning of the COVID-19 pandemic and leads to improved flexibility and better efficiency for patients, providers and hospitals,” Callie Hlavin, MD, MPH, a general surgery resident at the University of Pittsburgh Medical Center, told Healio. “We believe that telemedicine offers the opportunity to provide increased access to high quality care.”
Hlavin and colleagues analyzed 1,182 patients who underwent bariatric surgery at the University of Pittsburgh Medical Center, of whom 257 received telemedicine-based care (mean age, 40.8 years; 89.5% women) and 925 were evaluated in-person (mean age, 43 years; 82.8% women) before surgery. Researchers noted that a higher proportion of patients in the in-person group underwent Roux-en-Y gastric bypass (61.7% vs. 53.3%) compared with laparoscopic sleeve gastrectomy (38.3% vs. 46.7%).
Outcomes of interest included operating room delays, procedure duration, length of hospital stay and major adverse events, as well as postoperative hospital utilization, including ER visits or hospital readmission within 30 days of surgery.
According to results, there was no difference between in-person and telemedicine groups in mean times for operating room delays (7.8 min.; 95% CI, 5.1-10.5 vs. 4.2 min.; 95% CI, 1-7.4), procedure duration (134.4 min.; 95% CI, 130.9-137.8 vs. 105.3 min.; 95% CI, 100.2-110.4) and length of hospital stay (1.9 days; 95% CI, 1.8-1.9 vs. 2.1 days; 95% CI, 1.9-2.2), as well as major adverse events within 30 days (3.8%; 95% CI, 3-5.7 vs. 1.6%; 95% CI, 0.4-3.9%) and major adverse events between 31 and 60 days (2.2%; 95% CI, 1.3-3.3 vs. 1.6%; 95% CI, 0.4-3.9).
Researchers also reported no difference between in-person and telemedicine groups in the frequency of ER visits (18.8%; 95% CI, 16.3-21.4 vs. 17.9%; 95% CI, 13.2-22.6) or hospital readmission (10.1%; 95% CI, 8.1-12 vs. 6.6%; 95% CI, 3.9-10.4).
Using logistic regression modeling, researchers demonstrated that age (OR = 0.98; 95% CI, 0.97-0.99), surgery type (sleeve gastrectomy vs. Roux-en-Y: OR = 0.69; 95% CI, 0.5-0.94) and employment status (disabled vs. employed: OR = 2.33; 95% CI, 1.1-4.92) were associated with ER visits within 30 days, and sleeve gastrectomy was associated with decreased risk for 30-day hospital readmission (OR = 0.44; 95% CI, 0.28-0.69) and 30-day major adverse events (OR = 0.12; 95% CI, 0.04-0.4).
Hlavin acknowledged that more research is needed on follow-ups after 60 days, as well as barriers to and satisfaction with telemedicine use for patients and providers. She also noted that future studies should focus on expanding total telemedicine care into other surgical fields.
“Health care is becoming increasingly patient-centered, and our health care innovations must reflect this welcome change,” Hlavin told Healio. “Telemedicine can provide patients improved access to care and potentially narrow the disparities in care between rural and urban as well as high- and low-income communities.”
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