Impact of distance on postoperative follow-up in patients of pediatric surgery: a retrospective review

A Systematic Review of Telehealth Utilization for Bowel Management Programs in Pediatric Colorectal Surgery

Recent advancements in pediatric surgery have embraced telehealth (TH) modalities, transitioning from traditional in-person consultations to virtual care. This shift has broadened access to healthcare, potentially enhancing affordability, patient and caregiver satisfaction, and clinical outcomes. In pediatric colorectal surgery, telehealth has been effectively utilized to support Bowel Management Programs (BMPs) for children suffering from constipation and fecal incontinence. A systematic review was conducted to assess the effectiveness of virtual BMPs, analyzing studies from January 2010 to December 2023, sourced from MEDLINE (via PubMed), Embase, and the Cochrane Library, with five studies included. Remote BMPs, implemented through video or telephone consultations, reported satisfaction rates exceeding 75% among families, indicating a strong preference for virtual interactions over traditional visits. Significant findings from the studies include improvements in Vancouver and Baylor scores, reductions in the duration of multidisciplinary consultations, enhancements in pediatric quality of life and Cleveland scores, and decreased frequency of laxative treatments. The implementation of TH has facilitated patient-led care, enabling timely adjustments in treatment and efficient distribution of medical supplies. The findings suggest that virtual BMPs are a viable and effective alternative to conventional approaches, yielding high caregiver satisfaction and superior clinical outcomes while promoting patient independence.

Determining the Clinical Value of Routine Post Operative follow up in Common Paediatric Surgical Conditions: A Prospective Observational Study

Background

The traditional postoperative visit consists of an in-person hospital visit at a predetermined date which requires the investment of time and resources. This implies a need to prioritize visits rather than mandating them, which can be assessed by the requirement of clinical intervention at the time of follow-up. The purpose of this study is to determine the clinical value of routine postoperative physical follow-up in common pediatric surgery conditions, to identify factors determining follow-up, and to estimate the cost of routine follow-up.

Materials and Methods

Surgical data of 226 patients admitted for routine pediatric surgical procedures were collected. The postoperative period was documented in detail and interventions done either physically or telephonically at the time of follow-up were used as a proxy measure of clinical value.

Results

There were 226 patients enrolled, of which 64.60% followed up physically in outpatient department and 35.40% followed up telephonically. Maximum percentage of patients with postoperative complications belonged to the group of laparotomy at 22.22%, followed by complicated appendicitis at 15.62%. 13.27% of patients required clinical intervention at the time of follow-up.

Conclusion

Patients undergoing simpler procedures such as inguinal hernia, hydrocele, and orchidopexy have lesser rate of complications which translates to requirement of fewer clinic visits, whereas those undergoing procedures such as appendectomy and laparotomy require a physical visit after discharge since they are more susceptible to develop complications requiring interventions. By selecting patients for physical visit, we can potentially eliminate unnecessary visits in patients who have low chance of developing complications.

Utilization and Adequacy of Telemedicine for Outpatient Pediatric Surgical Care

INTRODUCTION

Telemedicine (TM) use accelerated out of necessity during the COVID-19 pandemic, but the utility of TM within the pediatric surgery population is unclear. This study measured utilization, adequacy, and disparities in uptake of TM in pediatric surgery during the COVID-19 pandemic.

METHODS

Scheduled outpatient pediatric surgery clinic encounters at a large academic children's hospital from January 2020 through March 2021 were reviewed. Sub-group analysis examined post-operative (PO) visits after appendectomy and umbilical, epigastric, and inguinal hernia repairs.

RESULTS

Of 9149 scheduled visits, 87.9% were in-person and 12.1% were TM. TM visits were scheduled for PO care (76.9%), new consultations (7.1%), and established patients (16.0%). Although TM visits were more frequently canceled or no shows (P < 0.001), most canceled TM visits were PO visits, of which 41.7% were canceled via electronic communication reporting the absence of any PO concerns. TM visits were adequate for accomplishing visit goals in 98.2%, 95.5%, and 96.2% of PO, new, and established patient visits, respectively. Patients utilizing TM visits were more frequently of white race, privately-insured, from less disadvantaged neighborhoods, and living a greater distance from clinic (P < 0.001 for all comparisons).

CONCLUSIONS

TM was adequate for the majority of visits in which it was utilized, including the basic PO visits that occurred via TM. TM was used more by patients with greater travel and less by those of minority race, with public insurance, and from more disadvantaged neighborhoods. Future work is necessary to ensure broad access to this useful tool for all children requiring surgical care.

Follow-up of children who undergo an uncomplicated surgical procedure: A caregiver survey to determine satisfaction, family impact, and preferences for alternate follow-up

BACKGROUND

Historically most surgical patients returned to clinic for an in-person postoperative follow-up. However, returning to hospital impacts the family in many ways. We hypothesized that in-person follow-up is not necessary after an uncomplicated procedure, and that caregivers would prefer an alternate follow-up.

METHODS

We surveyed caregivers of children less than 17 years of age who underwent a simple appendectomy, pyloromyotomy, cholecystectomy, or repair of an inguinal or umbilical hernia. With REB approval and caregiver consent, surveys were completed in-person during clinic visits and by telephone for alternate follow-up plans.

RESULTS

Despite interruptions due to COVID-19, 24 surveys were completed (clinic visit group N = 7, alternate plan group N = 17). Thirteen families resided in Winnipeg. The majority rated their overall satisfaction with follow-up as good-excellent (6/7 clinic group, 17/17 alternate group). The most frequent impacts to attend clinic were time off work (18/24), parking (17/24), gas costs (17/24), time from school (13/24) and childcare arrangements (12/24). The median estimated cost to attend clinic was 142 CAD$. Most families preferred an alternate plan (18/24) (i.e. call surgeon only if concerned, follow-up with their primary care provider or attend virtually). Only 4 children having an alternate follow-up plan required medical treatment for minor issues.

DISCUSSION

We conclude there is significant impact on families to attend a post-operative in-person clinic visit. Although all respondents rated their satisfaction highly, the majority preferred the option of an alternate plan. Surgeons should consider offering families alternate follow-up after an uncomplicated procedure.