Department of Spine Surgery, Hospital for Special Surgery, New York, NY.
Spine (Phila Pa 1976). 2022 Sep 1;47(17):1194-1202. doi: 10.1097/BRS.0000000000004387. Epub 2022 Jul 1.
A Retrospective cohort study.
To (1) assess whether diagnoses and surgical plans established during a new patient telemedicine visit changed following an in-person evaluation and (2) determine any differences in perioperative outcomes between patients who only had a telemedicine visit before surgery versus those who had a telemedicine visit followed by an in-person evaluation before surgery.
Data on capability of telemedicine to deliver high-quality preoperative assessment without a traditional in-person interaction and physical examination is lacking.
Records of patients who had a new patient telemedicine visit and indicated for surgery with documented specific diagnosis as well as surgical plans from a spine department at an urban tertiary center from April 2020 to April 2021 were reviewed. For a subset of patients that had a follow-up in-person evaluation before surgery, these diagnoses and plans were compared. Perioperative outcomes were compared between patients who only had a telemedicine visit before surgery versus those who had a telemedicine visit followed by an in-person evaluation before surgery.
A total of 166 patients were included. Of these, 101 patients (61%) only had a new patient telemedicine visit before surgery while 65 (39%) had a telemedicine visit followed by an in-person evaluation. There were no differences in the rate of case cancellations before surgery and patient-reported outcome measures between these two groups ( P >0.05). Of 65 patients who had both a telemedicine followed by an in-person visit, the diagnosis was unchanged for 61 patients (94%) and the surgical plan did not change for 52 patients (80%). The main reason for surgical plan change was due to updated findings on new imaging, 10 patients, (77%).
The current study suggests that telemedicine evaluations can provide an effective means of preoperative assessment for spine patients.
Level 3.
回顾性队列研究。
（1）评估新患者远程医疗就诊后，其诊断和手术计划在进行面对面评估后是否发生改变；（2）确定仅接受远程医疗就诊的患者与接受远程医疗就诊和手术前面对面评估的患者在围手术期结局方面的差异。
缺乏关于远程医疗在没有传统面对面互动和体检的情况下提供高质量术前评估能力的数据。
回顾了 2020 年 4 月至 2021 年 4 月期间，某城市三级中心脊柱科有记录的特定诊断和手术计划的新患者远程医疗就诊并指示手术的患者记录。对于部分在手术前有后续面对面评估的患者，比较了这些诊断和计划。比较了仅在手术前接受远程医疗就诊的患者与在手术前接受远程医疗就诊和面对面评估的患者之间的围手术期结局。
共纳入 166 例患者。其中，101 例（61%）患者仅接受了新患者远程医疗就诊，65 例（39%）患者接受了远程医疗就诊和手术前面对面评估。这两组患者的术前手术取消率和患者报告的结局测量指标没有差异（P>0.05）。在 65 例接受了远程医疗和面对面就诊的患者中，61 例（94%）的诊断未改变，52 例（80%）的手术计划未改变。手术计划改变的主要原因是新影像学更新的发现，10 例患者（77%）。
目前的研究表明，远程医疗评估可为脊柱患者提供有效的术前评估手段。
3 级。
