Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
World Neurosurg. 2022 Aug;164:e1043-e1048. doi: 10.1016/j.wneu.2022.05.091. Epub 2022 May 27.
The aim of this study was to compare accuracy of surgical plans generated from in-person and telemedicine evaluations and assess the reasons for surgical plan changes between initial evaluation and surgery. The secondary objective was to assess the effect of changes in surgical planning on postoperative outcomes.
In this retrospective cohort study, consecutive patients who were evaluated as new patients by orthopaedic spine faculty between 2019 and 2021 were divided by appointment type: telemedicine (n = 39) and in-person (n = 92). Patients were included if the surgeon documented a definitive surgical plan at the initial visit. The primary outcome was change in surgical plan from initial assessment to actual procedure performed.
There was no significant difference in the accuracy of initial surgical plans between the telemedicine and in-person cohorts (79.5% vs. 82.6%, P = 0.673). The most common modification in the surgical plan (79%) was change in the number of operated levels, of which 18 of 19 patients had 1 added operated level. Less common reasons were change in approach (13%) and change in procedure (8%). Patients with changes to their surgical plan experienced longer length of stay (3.1 vs. 2.0 days, P = 0.027) than patients with consistent surgical plans.
Telemedicine and in-person evaluations generated similarly accurate surgical plans. Changes to the initial surgical plans most often involved adding operative levels. Our findings show that telemedicine visits are an acceptable option for preoperative assessment to generate surgical plans; however, further research is needed.
本研究旨在比较来自远程医疗评估和现场评估的手术计划的准确性，并评估手术前评估与手术之间手术计划变更的原因。次要目的是评估手术计划变更对术后结果的影响。
在这项回顾性队列研究中，2019 年至 2021 年间，骨科脊柱教员对连续就诊的新患者，根据预约类型进行分组：远程医疗（n=39）和现场（n=92）。如果外科医生在首次就诊时记录了明确的手术计划，则纳入患者。主要结局是初始评估与实际手术过程之间手术计划的变化。
远程医疗组和现场组初始手术计划的准确性无显著差异（79.5% vs. 82.6%，P=0.673）。手术计划最常见的修改（79%）是手术节段数的变化，其中 19 例中有 18 例增加了一个手术节段。较少见的原因是手术入路的变化（13%）和手术方法的变化（8%）。手术计划发生变化的患者的住院时间更长（3.1 天 vs. 2.0 天，P=0.027），而手术计划保持不变的患者住院时间更短。
远程医疗和现场评估生成的手术计划同样准确。初始手术计划的变更最常涉及增加手术节段。我们的研究结果表明，远程医疗就诊是生成手术计划的一种可接受的术前评估方式；然而，需要进一步的研究。
