Gastrointestinal and General Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L 233A, Portland, OR, 97239, USA.
Hernia. 2024 Dec;28(6):2151-2157. doi: 10.1007/s10029-024-03095-9. Epub 2024 Sep 18.
In an era where telehealth is gaining traction within healthcare systems, its integration into preoperative assessment protocols presents both challenges and opportunities. Preoperative assessments have an important role in determining the best plan of action for each patient. Recent studies have reported adequate operative outcomes after telemedicine preoperative consultations. This study examines telehealth's efficacy relative to traditional in-person evaluations in the context of preoperative consultations for inguinal hernia repairs and provides a deeper insight into how telemedicine might be utilized for pre-surgical assessments.
We analyzed a prospectively maintained single-center database at a tertiary referral hospital with a dedicated hernia and abdominal wall reconstruction center for pre, intra and postoperative variables comparing patients that received telemedicine (phone or video) preoperative consultations versus in-person clinic visits only. Secondary analysis with propensity score matching was employed to adjust for possible confounders.
265 patients that underwent inguinal hernia repair were included, with 60 encounters being telemedicine only and the rest in-person. This analysis found no difference in rates of postoperative complications between the telemedicine and in-person groups. The telemedicine group required less preoperative encounters with their surgeon (P < 0.001). In the preoperative in-person group, 41% switched to virtual follow-ups, while in the virtual group, only 18% chose in-person follow-ups (P = 0.003).
Based on our analysis, the use of telemedicine for preoperative assessments in inguinal hernia repairs as a feasible and safe choice for patients opting for this approach, potentially reshaping the preoperative paradigm in surgical practices.
在医疗系统中远程医疗日益普及的时代，将其纳入术前评估方案既带来了挑战，也带来了机遇。术前评估在确定每位患者最佳行动方案方面发挥着重要作用。最近的研究报告称，远程医疗术前咨询后的手术结果令人满意。本研究考察了远程医疗在腹股沟疝修补术术前咨询方面相对于传统面对面评估的效果，并深入探讨了远程医疗在术前评估中的应用。
我们分析了一家三级转诊医院的前瞻性维护的单中心数据库，该医院设有专门的疝和腹壁重建中心，用于比较接受远程医疗（电话或视频）术前咨询的患者与仅接受面对面诊所就诊的患者的术前、术中和术后变量。采用倾向评分匹配进行二次分析以调整可能的混杂因素。
共纳入 265 例接受腹股沟疝修补术的患者，其中 60 例仅接受远程医疗，其余均为面对面就诊。分析发现远程医疗组和面对面组之间的术后并发症发生率无差异。远程医疗组与外科医生进行的术前就诊次数较少（P<0.001）。在面对面的术前就诊组中，41%的患者转为虚拟随访，而在虚拟组中，只有 18%的患者选择面对面随访（P=0.003）。
根据我们的分析，远程医疗可作为患者选择的一种可行且安全的选择，用于腹股沟疝修补术的术前评估，可能重塑外科实践中的术前模式。
