Two reports suggested value in trying newer communication methods to check in on patients recovering from surgery, the downside being that some health disparities may be worsened depending on the patients’ preferred language and digital literacy.
In the first study, investigators showed that telemedicine was sufficient as a way to follow up with patients who were discharged after low-risk surgery, though their small trial had been halted by COVID-19.
Video-based postdischarge visits were noninferior to in-hospital follow-up in terms of the proportion of patients returning for a hospital encounter within 30 days (12.8% vs 13.3%, P=0.89), according to Caroline Reinke, MD, MSHP, of Carolinas Medical Center in Charlotte, North Carolina, and colleagues.
Moreover, the virtual visits were typically about a half hour shorter than the usual in-person visit (mean 20.0 vs 47.5 minutes, P<0.001) but still provided patients with the same amount of time actually spent with their surgeons (8.4 vs 7.8 minutes, P=0.30), the authors reported in JAMA Surgery.
“Patients and clinicians should be reassured that the critical visit portion, time together discussing medical needs, is preserved,” Reinke’s group wrote. “This information will help surgeons and patients feel more confident in using video-based virtual visits.”
The randomized trial was conducted at two urban surgical centers within the Atrium Health system, starting in 2017. Return hospital encounters across the entire health system were recorded for the primary endpoint, though the authors did acknowledge the possibility that some people had encounters elsewhere.
Notably, the trial was interrupted in 2020 when the COVID-19 pandemic put a stop to postoperative clinic visits at study sites.
“Although we did not reach target enrollment, noninferiority was demonstrated for postdischarge virtual visits in our study sample and was further supported via a simulation model,” Reinke and colleagues said.
Eligible patients had received minimally invasive appendectomy or cholecystectomy by surgeons who cover emergency general surgery. The investigators screened 1,645 individuals and enrolled 432. Non-English speakers were among the most commonly excluded.
“The barriers to including non-English-speaking patients were unanticipated. Interpreters were readily available, but converting the third-party platform to other languages is a challenge that we continue to work through,” the authors wrote. “Another 50 patients were not eligible owing to a technology barrier.”
“It is important as telemedicine is adopted in the United States that careful attention is paid to the ability to provide care to all patients and avoid creating or worsening disparities,” Reinke’s team urged.
Participants were randomized 2:1 to video-based (289 patients) or in-person postdischarge visits (143 patients). The two groups were roughly comparable, with an average age in the late 30s, and more than 60% were women.
For reasons spanning from patient request to need for prescription pain medicine, 53 people in the telemedicine group crossed over to the in-person visit group.
Separately, the staff at one center reported that they could reach more patients the day after ambulatory surgery when they shifted to automated text messages instead of the usual telephone call.
Just 49.2% of surgical patients could be reached during the period in which all next-day contact was conducted by telephone (May 1, 2016 to April 30, 2017), compared with 85.3% during the test period when nurses told all patients to expect a text message the next day (July 1, 2017 to June 30, 2018; P<0.001).
The improvement in successful follow-up was accompanied by significantly greater satisfaction among the five participating nurses and no drop in patient satisfaction as measured in a questionnaire, in a study reported by Marie-Laure Cittanova, MD, PhD, of Clinique Saint Jean de Dieu in Paris, and colleagues.
Additionally as they noted in the quality-improvement study published as a research letter in JAMA Network Open, the results showed that follow-up was cheaper with the automated text messages, which cost about $2.09 per patient (vs $3.12 per patient per call).
All consecutive adults admitted for same-day surgery (except cataract surgery) at Cittanova’s center were included in the study. They were divided between patients from the telephone call phase (8,134 patients; 40% men, mean age 58) and peers from the text message phase (9,325 patients; 39% men, mean age 56).
The single-center study was limited in its generalizability and also lacked long-term outcomes, the researchers noted. Moreover, they also warned of the possibility of an automated text message program introducing disparities in care due to differences in familiarity and use of text messaging among patients.
The randomized trial was funded by the American College of Surgeons Franklin H. Martin Faculty Research Fellowship.
Reinke and co-authors had no conflict of interest disclosures.
Cittanova had no disclosures; a co-author reported financial relationships with Aspen, Gilead, Amomed, Merck Sharp & Dohme, Octapharma, and Edwards LifeSciences outside of the study.