远程医疗诊所作为良性胆囊疾病患者择期腹腔镜胆囊切除术术前面对面评估替代方式的安全性：一项回顾性队列研究。
The safety of telemedicine clinics as an alternative to in-person preoperative assessment for elective laparoscopic cholecystectomy in patients with benign gallbladder disease: a retrospective cohort study.
作者信息
Urbonas Tomas, Lakha Adil Siraj, King Emily, Pepes Sophia, Ceresa Carlo, Udupa Venkatesha, Soonawalla Zahir, Silva Michael A, Gordon-Weeks Alex, Reddy Srikanth
机构信息
Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England.
出版信息
Patient Saf Surg. 2023 Aug 29;17(1):23. doi: 10.1186/s13037-023-00368-7.
BACKGROUND
The telemedicine clinic for follow up after minor surgical procedures in general surgery is now ubiquitously considered a standard of care. However, this method of consultation is not the mainstay for preoperative assessment and counselling of patients for common surgical procedures such as laparoscopic cholecystectomy. The aim of this study was to evaluate the safety of assessing and counselling patients in the telemedicine clinic without a physical encounter for laparoscopic cholecystectomy.
METHODS
We conducted a retrospective analysis of patients who were booked for laparoscopic cholecystectomy for benign gallbladder disease via general surgery telemedicine clinics from March 2020 to November 2021. The primary outcome was the cancellation rate on the day of surgery. The secondary outcomes were complication and readmission rates, with Clavein-Dindo grade III or greater deemed clinically significant. We performed a subgroup analysis on the cases cancelled on the day of surgery in an attempt to identify key reasons for cancellation following virtual clinic assessment.
RESULTS
We identified 206 cases booked for laparoscopic cholecystectomy from telemedicine clinics. 7% of patients had a cancellation on the day of surgery. Only one such cancellation was deemed avoidable as it may have been prevented by a face-to-face assessment. Severe postoperative adverse events (equal to or greater than Clavien-Dindo grade III) were observed in 1% of patients, and required re-intervention. 30-day readmission rate was 11%.
CONCLUSIONS
Our series showed that it is safe and feasible to assess and counsel patients for laparoscopic cholecystectomy remotely with a minimal cancellation rate on the day of operation. Further work is needed to understand the effect of remote consultations on patient satisfaction, its environmental impact, and possible benefits to healthcare economics to support its routine use in general surgery.
背景
普通外科小手术后的远程医疗随访诊所如今已被普遍视为一种护理标准。然而，对于诸如腹腔镜胆囊切除术等常见外科手术，这种会诊方式并非术前评估和患者咨询的主要手段。本研究的目的是评估在远程医疗诊所对患者进行腹腔镜胆囊切除术评估和咨询而不进行面对面接触的安全性。
方法
我们对2020年3月至2021年11月通过普通外科远程医疗诊所预约进行良性胆囊疾病腹腔镜胆囊切除术的患者进行了回顾性分析。主要结局是手术当天的取消率。次要结局是并发症和再入院率，Clavein-Dindo III级或更高等级被视为具有临床意义。我们对手术当天取消的病例进行了亚组分析，试图确定虚拟诊所评估后取消手术的关键原因。
结果
我们从远程医疗诊所确定了206例预约进行腹腔镜胆囊切除术的病例。7%的患者在手术当天取消了手术。只有一例这样的取消被认为是可以避免的，因为通过面对面评估可能可以预防。1%的患者观察到严重的术后不良事件（等于或大于Clavien-Dindo III级），需要再次干预。30天再入院率为11%。
结论
我们的系列研究表明，对患者进行腹腔镜胆囊切除术的远程评估和咨询是安全可行的，手术当天的取消率极低。需要进一步开展工作，以了解远程会诊对患者满意度的影响、其环境影响以及对医疗经济学可能带来的益处，以支持其在普通外科的常规应用。
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