1
|
Felix Z, Salgado-Garza G, Porter CG, Nouboussi N, O'Connor AL, Bazarian A, Nikolian VC. Postoperative outcomes among patients evaluated via telemedicine-based preoperative consultations for inguinal hernia care. Hernia 2024:10.1007/s10029-024-03095-9. [PMID: 39289185 DOI: 10.1007/s10029-024-03095-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 06/11/2024] [Indexed: 09/19/2024]
Abstract
PURPOSE In an era where telehealth is gaining traction within healthcare systems, its integration into preoperative assessment protocols presents both challenges and opportunities. Preoperative assessments have an important role in determining the best plan of action for each patient. Recent studies have reported adequate operative outcomes after telemedicine preoperative consultations. This study examines telehealth's efficacy relative to traditional in-person evaluations in the context of preoperative consultations for inguinal hernia repairs and provides a deeper insight into how telemedicine might be utilized for pre-surgical assessments. METHODS We analyzed a prospectively maintained single-center database at a tertiary referral hospital with a dedicated hernia and abdominal wall reconstruction center for pre, intra and postoperative variables comparing patients that received telemedicine (phone or video) preoperative consultations versus in-person clinic visits only. Secondary analysis with propensity score matching was employed to adjust for possible confounders. RESULTS 265 patients that underwent inguinal hernia repair were included, with 60 encounters being telemedicine only and the rest in-person. This analysis found no difference in rates of postoperative complications between the telemedicine and in-person groups. The telemedicine group required less preoperative encounters with their surgeon (P < 0.001). In the preoperative in-person group, 41% switched to virtual follow-ups, while in the virtual group, only 18% chose in-person follow-ups (P = 0.003). CONCLUSIONS Based on our analysis, the use of telemedicine for preoperative assessments in inguinal hernia repairs as a feasible and safe choice for patients opting for this approach, potentially reshaping the preoperative paradigm in surgical practices.
Collapse
Affiliation(s)
- Zev Felix
- Gastrointestinal and General Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L 233A, Portland, OR, 97239, USA
| | - Gustavo Salgado-Garza
- Gastrointestinal and General Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L 233A, Portland, OR, 97239, USA
| | - Caroline G Porter
- Gastrointestinal and General Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L 233A, Portland, OR, 97239, USA
| | - Nelly Nouboussi
- Gastrointestinal and General Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L 233A, Portland, OR, 97239, USA
| | - Amber L O'Connor
- Gastrointestinal and General Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L 233A, Portland, OR, 97239, USA
| | - Alina Bazarian
- Gastrointestinal and General Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L 233A, Portland, OR, 97239, USA
| | - Vahagn C Nikolian
- Gastrointestinal and General Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L 233A, Portland, OR, 97239, USA.
| |
Collapse
|
2
|
O'Connor AL, Shmelev A, Shettig A, Santucci NM, Bray J, Bazarian A, Orenstein SB, Nikolian VC. Assessing Patient-Reported Experiences for In-Person and Telemedicine-Based Preoperative Evaluations. Telemed J E Health 2024; 30:472-479. [PMID: 37624627 DOI: 10.1089/tmj.2023.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Background: The COVID-19 pandemic has transformed health care delivery through the rise of telehealth solutions. Though telemedicine-based care has been identified as safe and feasible in postoperative care, data on initial surgical consultations in the preoperative setting are lacking. We sought to compare patient characteristics, anticipated downstream care utilization, and patient-reported experiences (PREs) for in-person versus telemedicine-based care conducted for initial consultation encounters at a hernia and abdominal wall center. Methods: Patients evaluated at an abdominal wall reconstruction center from August 2021 to August 2022 were prospectively surveyed. Patient characteristics, anticipated downstream care utilization, and PREs were compared. Results: Of the 176 respondents, 50.6% (n = 89) utilized telemedicine-based care and had similar demographic and disease characteristics to those receiving in-person care. Telemedicine-based care saved a median of 47 min [interquartile range 20-112.5 min] of round-trip travel time per patient, with 10.1% of encounters resulting in supplemental in-person evaluation. A large proportion of telemedicine-based and in-person encounters resulted in recommendations for operative intervention, 38.2% versus 55.2%, respectively. Indirect costs of care were significantly lower for patients utilizing telemedicine-based services. Patient satisfaction related to encounters was non-inferior to in-person care. Overall, the majority of patients responded that they preferred future care to be delivered via telemedicine-based services, if offered. Conclusions: Preoperative telemedicine-based care was associated with significant cost-savings over in-person care related with comparable patient satisfaction. Health systems should continue to dedicate resources to optimizing and expanding perioperative telemedicine capabilities.
Collapse
Affiliation(s)
- Amber L O'Connor
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Artem Shmelev
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Abigale Shettig
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Nicole M Santucci
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Jordan Bray
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Alina Bazarian
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Sean B Orenstein
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Vahagn C Nikolian
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
3
|
Bray JO, O'Connor S, Sutton TL, Santucci NM, Elsheikh M, Bazarian AN, Orenstein SB, Nikolian VC. Patient-performed at-home surgical drain removal is safe and feasible following hernia repair and abdominal wall reconstruction. Am J Surg 2023; 225:388-393. [PMID: 36167625 DOI: 10.1016/j.amjsurg.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/11/2022] [Accepted: 09/18/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Traditionally, surgical drains are considered a relative contraindication to telemedicine-based postoperative care. We sought to assess the safety, feasibility, and outcomes of an at-home patient-performed surgical drain removal pilot program. METHODS A prospective cohort study among patients who were discharged with surgical drains was performed. Patients discharged with drains were given the option for in-clinic, provider-performed removal, or at-home, patient-performed drain removal. Patient demographics, health characteristics, perioperative metrics, and operative outcomes were compared and analyzed. RESULTS A total of 68 encounters with drain removal were included (at-home: 28%, n = 19; in-clinic: 72%, n = 49), with both groups having similar demographics, except for age (median age of telemedicine-based at-home: 50 vs in-clinic: 62 years, p = 0.03). Patients who opted into at-home, patient-performed drain removal were more likely to have drain removal occur earlier (9 vs 13 days for in-clinic, p < 0.001). In-clinic removal resulted in increased encounters with surgical nursing staff and increased travel time, with no significant difference in complication burden. CONCLUSIONS Patient-performed at-home drain removal is safe and allows for more timely drain removal.
Collapse
Affiliation(s)
- Jordan O Bray
- Oregon Health & Science University, Portland, OR, USA
| | | | | | | | | | | | | | | |
Collapse
|