Total pre-operative telemedicine in bariatric surgery is associated with non-inferior clinical outcomes and hospital utilisation compared with traditional, in-person patient care, according to investigators led by a team from the University of Pittsburgh, Pittsburgh, PA.
The study authors, who compared post-operative clinical outcomes and hospital utilisation after telemedicine or in-person pre-operative surgical evaluation in patients treated at a US academic hospital, concluded that "Telemedicine may expand the reach of bariatric surgery and narrow disparities for historically disinvested patient populations." The findings, 'Clinical Outcomes and Hospital Utilization Among Patients Undergoing Bariatric Surgery With Telemedicine Preoperative Care', were published in JAMA Network.
Subsequently, they carried out a single-institution, retrospective, noninferiority cohort study in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines. Telemedicine visits were video-based and were performed by a combination of surgical attending physicians, fellows, residents, advance practice clinicians and nurses. They compared the telemedicine group with a historical control group of patients who had surgery after traditional in-person surgical evaluation.
Outcomes
Patients in the telemedicine group (257 patients) were younger (mean [SD] age, 40.8 [12.5] years vs 43.0 [12.2]; p=0.01) and more likely to be female (230 of 257 [89.5%] vs 766 of 925 [82.8%]; p=0.01) compared with the control group (925 patients). Race and ethnicity between the two groups were not statistically different (telemedicine group: 53 [20.6%] Black, 0 Hispanic or Latinx, 192 [74.7%] White vs control group: 185 [20.0%] Black, 10 [1.1%] Hispanic, 711 [76.9%] White; p=0.20). English was preferred in a higher percentage of the control cases compared with the telemedicine group (910 of 925 [98.4%] vs 255 of 257 [99.2%]).
The control group had more Medicare enrolees (156 of 925 [16.9%] vs 5 of 257 [2.0%]) and Medicaid enrolees (63 of 925 [6.8%] vs 1 of 257 [0.4%]) as well as uninsured patients (85 of 925 [9.2%] vs 7 of 257 [2.7%]) and those with unknown insurance status (29 of 925 [3.1%] vs none). Among the telemedicine group, a higher proportion of patients had private insurance coverage compared with the control group (244 of 257 [94.9%] vs 592 of 925 [64.0%]; p<0.001).
Patients in the control group had significantly higher frequency of anxiety or depression (499 of 925 [54.0%] vs 108 of 257 [42.0%]; p<0.001), type 2 diabetes (175 of 925 [18.9%] vs 22 of 257 [8.6%]; p<0.001), dyslipidaemia (291 of 925 [31.5%] vs 52 of 257 [20.2%]; p<0.001), gastroesophageal reflux disease (430 of 925 [46.5%] vs 80 of 257 [31.1%]; p<0.001), hypertension (448 of 925 [48.4%] vs 90 of 257 [35.0%]; p<0.001), and obstructive sleep apnoea (648 of 925 [70.1%] vs 73 of 257 [28.5%]; p<0.001). A higher proportion of patients in the control group underwent RYGB (571 of 925 [61.7%] vs 137 of 257 [53.3%]) vs. SG (354 of 925 [38.3%] vs 120 of 257 [46.7%]).
The researchers stated that outcomes in the telemedicine group were not inferior vs. the control group and there was no difference between the control and telemedicine groups with regards to operating room delay (time to operating room), procedure duration, length of hospital stay, major adverse events within 30 days and MAEs between 31 and 60 days. Hospital utilisation in the telemedicine group was non-inferior to the control group and they saw no differences in the frequency of ED visits or hospital readmission between the control and telemedicine groups.
The type of bariatric surgery was associated with higher likelihood of hospital readmission, with sleeve gastrectomy associated with lower odds of both 30-day hospital readmission (p=0.001) and 30-day MAE (p=0.001). There were no variables that were associated with higher likelihood of MAE between 31 and 60 days, and telemedicine use was not associated with any of the above outcomes.
“Further investigations should focus on geographical differences between telemedicine and traditional, in-person patient populations and ensure both patient and clinician satisfaction,” the authors concluded. “In addition, the total telemedicine design should be studied prospectively to identify patient and provider barriers to its use. Future implementation and dissemination may be beneficial in other surgical fields.”
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