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远程医疗在微创机器人泌尿外科手术前仅进行术前评估的安全性和可行性。

Safety and Feasibility of Telehealth Only Preoperative Evaluation Before Minimally Invasive Robotic Urologic Surgery.

机构信息

Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

出版信息

J Endourol. 2022 Aug;36(8):1070-1076. doi: 10.1089/end.2021.0819. Epub 2022 Jul 5.

Abstract

Telehealth utilization has increased dramatically over the past few years due to improvement in technology and the COVID-19 pandemic. To date, no study has examined whether a telehealth visit alone for preoperative evaluation is safe and sufficient before surgery. We examined the safety and feasibility of preoperative telehealth visits alone before minimally invasive urologic surgery. Single institution retrospective review of robotic prostate, kidney, and cystectomy procedures between April and December 2020. Cases were dichotomized into those who underwent preoperative evaluation by telehealth only traditional in-person visits. Outcomes included complications, blood loss, conversion to open surgery rates, and operative times. We assessed efficiency of care by measuring time from preoperative visit to surgery. Three hundred fourteen patients were included in the study, with 14% of cases ( = 45) being performed after a preoperative telehealth visit. The majority of cases included in analysis were robotic surgeries of the prostate (56.1% of all cases,  = 176) and the kidney (35.0% of all cases,  = 110). Patients seen via telehealth alone preoperatively had no significant differences in any grade of complications, perioperative outcomes, blood loss, operative time, and length of stay. There was no difference in change in anticipated procedure between the groups, and there was no case of conversion to open surgery in the telehealth only group. Time from preoperative visit to surgery was significantly shorter for the telehealth group by 13 days. Our study is the first to analyze the safety of telehealth only preoperative visits before minimally invasive urologic surgery. We found no difference in perioperative outcomes including conversion to open surgery or change in planned procedure. Furthermore, telehealth preoperative visits appeared to facilitate shorter time to surgery. This study has important implications for expediting patient care and medicolegal considerations.

摘要

由于技术的进步和 COVID-19 大流行,远程医疗的使用在过去几年中大幅增加。迄今为止,尚无研究探讨仅通过远程医疗进行术前评估是否在手术前是安全且足够的。我们研究了微创泌尿科手术前仅通过远程医疗进行术前访视的安全性和可行性。 这是对 2020 年 4 月至 12 月期间机器人前列腺、肾脏和膀胱切除术的单机构回顾性研究。病例分为仅通过远程医疗进行术前评估和传统的亲自访视两种情况。结果包括并发症、出血量、转为开放手术的比例和手术时间。我们通过测量从术前访视到手术的时间来评估护理效率。 该研究纳入了 314 例患者,其中 14%(45 例)的病例是在术前远程医疗访视后进行的。分析中包括的大多数病例是前列腺(所有病例的 56.1%,176 例)和肾脏(所有病例的 35.0%,110 例)的机器人手术。仅通过远程医疗进行术前访视的患者在任何等级的并发症、围手术期结果、出血量、手术时间和住院时间方面均无显著差异。两组之间预期手术的变化没有差异,并且在仅远程医疗组中没有转为开放手术的病例。远程医疗组从术前访视到手术的时间明显缩短了 13 天。 我们的研究首次分析了微创泌尿科手术前仅通过远程医疗进行术前访视的安全性。我们没有发现围手术期结果(包括转为开放手术或改变计划手术)的差异。此外,远程医疗术前访视似乎可以缩短手术时间。这项研究对于加快患者护理和医疗法律方面具有重要意义。

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