Llaneras Noah S, Taylor Ruby L, Orr Jonah P M, Alessio Rachel, Carper Carolyn, Patterson Brendan M, Mackinnon Susan E
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.
Plast Reconstr Surg Glob Open. 2025 Jun 26;13(6):e6892. doi: 10.1097/GOX.0000000000006892. eCollection 2025 Jun.
The COVID-19 pandemic accelerated the adoption of telemedicine for surgical consultations. Although patient satisfaction has been well documented, limited research exists regarding telemedicine's effectiveness in determining the ability to indicate for surgical care compared with in-office visits. We conducted a retrospective review comparing surgical decision-making via telemedicine versus in-person consultations, hypothesizing that in-office visits would be more effective in establishing a surgical plan than telemedicine.
A retrospective review of the medical records of all new patients presenting to the senior author's nerve surgery clinic at a high-volume quaternary referral center between June 2020 and January 2023 was performed. Surgical consultations were categorized as (1) surgery recommended, (2) surgery not recommended, (3) further screening required, or (4) surgery declined. The Fisher exact test compared the distribution of these categories between consultation types and the proportion of patients who underwent surgery after an initial recommendation.
Of the 809 patients, 283 (35%) had in-person and 526 (65%) had telemedicine consultations. Surgery was recommended in 49.5% of in-person consultations compared with 38% of telemedicine consultations ( = 0.03). Among those recommended for surgery at the initial visit, 77.9% of in-person and 77.8% of telemedicine patients ultimately underwent surgery ( = 0.10). Of the telemedicine patients subsequently seen in the office and offered surgery, 84.5% ultimately underwent that surgery.
Our findings suggest that telemedicine and in-office visits are equally effective in establishing a surgical plan, suggesting that the expansion of telemedicine could be considered for a broader geographic patient base.
新冠疫情加速了远程医疗在外科会诊中的应用。尽管患者满意度已有充分记录，但与门诊就诊相比，关于远程医疗在确定手术治疗指征能力方面有效性的研究有限。我们进行了一项回顾性研究，比较通过远程医疗与面对面会诊进行手术决策的情况，假设门诊就诊在制定手术计划方面比远程医疗更有效。
对2020年6月至2023年1月期间在一家大型四级转诊中心的资深作者神经外科诊所就诊的所有新患者的病历进行回顾性研究。外科会诊分为以下几类：（1）建议手术；（2）不建议手术；（3）需要进一步筛查；或（4）拒绝手术。采用Fisher精确检验比较不同会诊类型之间这些类别的分布情况以及初次建议后接受手术的患者比例。
809例患者中，283例（35%）进行了面对面会诊，526例（65%）进行了远程医疗会诊。面对面会诊中有49.5%建议手术，而远程医疗会诊中这一比例为38%（P = 0.03）。在初次就诊时建议手术的患者中，面对面会诊患者中有77.9%、远程医疗患者中有77.8%最终接受了手术（P = 0.10）。在随后到门诊就诊并被建议手术的远程医疗患者中，84.5%最终接受了该手术。
我们的研究结果表明，远程医疗和门诊就诊在制定手术计划方面同样有效，这表明可以考虑将远程医疗扩展到更广泛地区的患者群体。
