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胆囊切除术后的远程医疗随访对退伍军人是安全的。

Telehealth follow-up after cholecystectomy is safe in veterans.

机构信息

Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO, 80045, USA.

Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.

出版信息

Surg Endosc. 2023 Apr;37(4):3201-3207. doi: 10.1007/s00464-022-09501-6. Epub 2022 Aug 16.

Abstract

BACKGROUND

The COVID-19 pandemic has brought many challenges including barriers to delivering high-quality surgical care and follow-up while minimizing the risk of infection. Telehealth has been increasingly utilized for post-operative visits, yet little data exists to guide surgeons in its use. We sought to determine safety and efficacy of telehealth follow-up in patients undergoing cholecystectomy during the global pandemic at a VA Medical Center (VAMC).

METHODS

This was a retrospective review of patients undergoing cholecystectomy at a level 1A VAMC over a 2-year period from August 2019 to August 2021. Baseline demographics, post-operative complications, readmissions, emergency department (ED) visits and need for additional procedures were reviewed. Patients who experienced a complication prior to discharge, underwent a concomitant procedure, had non-absorbable skin closure, had new diagnosis of malignancy or were discharged home with drain(s) were ineligible for telehealth follow-up and excluded.

RESULTS

Over the study period, 179 patients underwent cholecystectomy; 30 (17%) were excluded as above. 20 (13%) missed their follow-up, 52 (35%) were seen via telehealth and 77 (52%) followed-up in person. There was no difference between the two groups regarding baseline demographics or intra-operative variables. There was no significant difference in post-operative complications [4 (8%) vs 6 (8%), p > 0.99], ED utilization [5 (10%) vs 7 (9%), p = 0.78], 30-day readmission [3 (6%) vs 6 (8%), p = 0.74] or need for additional procedures [2 (4%) vs 4 (5%), p = 0.41] between telehealth and in-person follow-up.

CONCLUSION

Telehealth follow-up after cholecystectomy is safe and effective in Veterans. There were no differences in outcomes between patients that followed up in-person vs those that were seen via phone or video. Routine telehealth follow-up after uncomplicated cholecystectomy should be considered for all patients.

摘要

背景

新冠疫情大流行带来了诸多挑战,包括在尽量降低感染风险的同时提供高质量外科护理和后续治疗的障碍。远程医疗已经越来越多地用于术后随访,但指导外科医生使用远程医疗的相关数据却很少。我们旨在确定在退伍军人事务部医疗中心(VAMC),在大流行期间对接受胆囊切除术的患者使用远程医疗随访的安全性和有效性。

方法

这是对 2019 年 8 月至 2021 年 8 月期间在 1 级 A 类 VAMC 接受胆囊切除术的患者进行的回顾性研究。回顾了基线人口统计学特征、术后并发症、再入院、急诊就诊和需要进一步治疗的情况。在出院前发生并发症、同时进行其他手术、使用不可吸收皮肤缝线、新诊断为恶性肿瘤或出院时带引流管的患者不符合远程医疗随访条件,被排除在外。

结果

在研究期间,有 179 名患者接受了胆囊切除术;有 30 名(17%)因上述原因被排除。20 名(13%)患者错过了随访,52 名(35%)通过远程医疗就诊,77 名(52%)亲自就诊。两组患者在基线人口统计学特征或手术变量方面无差异。术后并发症发生率无显著差异[4(8%)比 6(8%),p>0.99],急诊就诊率[5(10%)比 7(9%),p=0.78],30 天再入院率[3(6%)比 6(8%),p=0.74]或需要进一步治疗的比率[2(4%)比 4(5%),p=0.41]也无差异。

结论

在退伍军人中,胆囊切除术后进行远程医疗随访是安全有效的。在亲自就诊的患者和通过电话或视频就诊的患者之间,结局没有差异。对于所有接受过简单胆囊切除术的患者,都应考虑常规进行远程医疗随访。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5c9a/9380680/1b1741bd5575/464_2022_9501_Fig1_HTML.jpg

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