Uppal Abhineet, Kothari Anai N, Scally Christopher P, Roland Christina L, Bednarski Brian K, Katz Matthew H G, Vauthey Jean-Nicholas, Chang George J
University of Texas MD Anderson Cancer Center, Department of Colon and Rectal Surgery, Division of Surgery, Houston, TX.
University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Division of Surgery, Houston, TX.
JCO Oncol Pract. 2022 Jul;18(7):e1091-e1099. doi: 10.1200/OP.21.00819. Epub 2022 Mar 9.
The COVID-19 pandemic has resulted in significant changes in health care delivery, including the rapid adoption of telemedicine across multiple specialties and practice environments. This includes postoperative visits (POV), despite limited data on outcomes following these telemedicine POV. We sought to determine whether these types of visits successfully identify and address postoperative complications when compared with in-person POV.
This was a retrospective cohort study of patients undergoing elective inpatient cancer-related surgery from March 2020 through December 2020. The exposure variable was type of POV (telemedicine in-person). The primary outcome was unplanned hospital readmission within 90 days, and secondary outcomes included 30-day readmission, length of stay of first readmission, and mortality.
Five-hundred thirty-five patients underwent elective inpatient operations and met our inclusion criteria. Of these, 98 (18.5%) had an initial telemedicine POV. There was no difference in 90-day readmission on the basis of POV type (16.3% telemedicine 16.5% in-person, = .99). Reasons for readmission did not differ between patients who underwent a telemedicine POV compared with in-person POV (all > .05). After adjustment for patients' demographic and clinical factors, telemedicine POV was not associated with 90-day readmission (odds ratio, 0.89; 95% CI, 0.43 to 1.70; = .77).
Telemedicine POV use adopted during the COVID-19 pandemic did not increase risk of readmission when compared with in-person visits following inpatient oncologic surgery. These data can help inform policy on the continued use and application of telemedicine after the pandemic.
新冠疫情导致医疗服务发生了重大变化，包括多个专科和执业环境迅速采用远程医疗。这其中包括术后随访（POV），尽管关于这些远程医疗术后随访结果的数据有限。我们试图确定与面对面术后随访相比，这类随访能否成功识别并处理术后并发症。
这是一项回顾性队列研究，研究对象为2020年3月至2020年12月接受择期住院癌症相关手术的患者。暴露变量为术后随访类型（远程医疗或面对面）。主要结局是90天内非计划住院再入院，次要结局包括30天再入院、首次再入院的住院时间和死亡率。
535例患者接受了择期住院手术并符合纳入标准。其中，98例（18.5%）进行了首次远程医疗术后随访。基于术后随访类型的90天再入院率无差异（远程医疗为16.3%，面对面为16.5%，P = 0.99）。与面对面术后随访的患者相比，接受远程医疗术后随访的患者再入院原因无差异（所有P>0.05）。在对患者的人口统计学和临床因素进行调整后，远程医疗术后随访与90天再入院无关（优势比为0.89；95%可信区间为0.43至1.70；P = 0.77）。
与住院肿瘤手术后的面对面随访相比，新冠疫情期间采用的远程医疗术后随访并未增加再入院风险。这些数据有助于为疫情后远程医疗的持续使用和应用提供政策参考。
