Bednarski Brian K, Slack Rebecca S, Katz Matthew, You Y Nancy, Papadopolous John, Rodriguez-Bigas Miguel A, Skibber John M, Matin Surena F, Chang George J
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas.
Dis Colon Rectum. 2018 Jan;61(1):77-83. doi: 10.1097/DCR.0000000000000945.
Ileostomies are a routine part of the care of patients with rectal cancer, but are associated with significant risk for dehydration, readmission, and acute kidney injury. Telemedicine has proven beneficial in decreasing readmission in chronic medical illnesses, but its utility in patients with an ileostomy is not well studied.
The purpose of this study was to evaluate the feasibility of televideoconferencing in the assessment of ileostomy output.
An institutional review board-approved, prospective clinical trial was conducted at a single institution from November 2014 through December 2015.
The study was conducted in a single, large academic medical center.
Patients >18 years of age undergoing surgery with plans for ileostomy were eligible.
Televideoconference assessments of ileostomy output and the need for medical intervention were conducted during the postoperative stay and compared with in-person assessment.
The primary end point of the trial was the feasibility of using teleconferencing to assess the need for medical intervention, defined as 90% agreement between telemedicine and in-person assessments. Secondary end points included patient/provider satisfaction, and correlative studies examined dehydration events and readmission.
Twenty-seven patients underwent 44 teleconferencing assessments of ileostomy output. Compared with in-person treatment decisions, there was a 95% match (95% CI, 85%-99%). The readmission rate for the study participants was 31%, and 18% experienced dehydration events. Both patients and faculty responded favorably to surveys regarding the use of telemedicine in the perioperative period.
The study is limited by its in-hospital use of technology and small sample size.
Televideoconference evaluation is a feasible, reliable means of assessing ileostomy output with high patient and physician acceptance. Our pilot study provides rationale for further study in the postdischarge setting for patients with ileostomies. The incorporation of televideoconference assessment within a teledischarge program may enable early intervention to improve patient outcomes. See Video Abstract at http://links.lww.com/DCR/A455.
回肠造口术是直肠癌患者护理的常规部分，但与脱水、再次入院和急性肾损伤的重大风险相关。远程医疗已被证明有助于减少慢性疾病的再次入院率，但其在回肠造口术患者中的效用尚未得到充分研究。
本研究的目的是评估电视电话会议在评估回肠造口术排出量方面的可行性。
2014年11月至2015年12月在单一机构进行了一项经机构审查委员会批准的前瞻性临床试验。
该研究在一个大型学术医疗中心进行。
年龄大于18岁且计划接受回肠造口术手术的患者符合条件。
在术后住院期间通过电视电话会议评估回肠造口术排出量及医疗干预需求，并与面对面评估进行比较。
试验的主要终点是使用电话会议评估医疗干预需求的可行性，定义为远程医疗评估与面对面评估之间达成90%的一致性。次要终点包括患者/提供者满意度，相关研究考察了脱水事件和再次入院情况。
27例患者接受了44次回肠造口术排出量的电视电话会议评估。与面对面的治疗决策相比，匹配率为95%（95%CI，85%-99%）。研究参与者的再次入院率为31%，18%发生了脱水事件。患者和医务人员对围手术期使用远程医疗的调查反馈良好。
本研究受限于其在医院内对技术的使用和样本量较小。
电视电话会议评估是一种可行、可靠的评估回肠造口术排出量的方法，患者和医生接受度高。我们的初步研究为在回肠造口术患者出院后进行进一步研究提供了理论依据。将电视电话会议评估纳入远程出院计划可能有助于早期干预以改善患者结局。见视频摘要：http://links.lww.com/DCR/A455 。
