How Does Telemedicine Compare to Conventional Follow-Up After General Surgery?

Main results. Two-hundred patients were randomly allocated to 1 of the 2 groups, with 100 patients in each group. The groups did not differ significantly based on age (P = 0.836), gender (P = 0.393), or American Society of Anesthesiologists (ASA) score (P = 0.232). Time to visit did not differ significantly between the groups (P = 0.169), and while visits were generally shorter in the telemedicine group, the difference was not significant (P = 0.153). Diagnoses and treatments did not differ significantly between the groups (P = 0.853 and P = 0.461, respectively).

The primary outcome (follow-up feasibility) was achieved in 90% of the conventional follow-up group and in 74% of the telemedicine group (P = 0.003). Of the 10 patients in the conventional follow-up group who did not complete the follow-up, 8 did not attend the visit on the scheduled day and 2 were hospitalized for reasons not related to the study. In the telemedicine group, the 2 main reasons for failure to follow-up were technical difficulties (n = 10) and requests by patients to attend a conventional visit after being allocated to the telemedicine group (n = 10). Among the remaining 6 patients in the telemedicine group who did not attend a visit, 3 visited the outpatient clinic because of a known surgical wound infection before the visit, 2 did not respond to the video call and could not be contacted by other means, and 1 had other face-to-face visits scheduled in different departments of the hospital the same day as the telemedicine appointment.

There were no statistically significant differences in the clinical results of the 164 patients meeting the primary endpoint (P = 0.832). Twelve of the 90 (13.3%) patients in the conventional group attended extra visits after the follow-up, while 9 of the 74 patients (12.1%) in the telemedicine group (P = 0.823) attended extra visits after follow-up. The median global patient satisfaction score was 5 in both the conventional group (range, 2-5) and the telemedicine group (range, 1-5), with no statistically significant differences (P = 0.099). When patients in the telemedicine group were asked if they would accept the use of telemedicine as part of their medical treatment on an ongoing basis, they rated the proposition with a median score of 5 (range, 1-5).

Conclusion. Telemedicine is a feasible and acceptable complementary service to facilitate postoperative management in selected general surgery patients. This option produces good satisfaction rates and maintains clinical outcomes.

Commentary

In recent years, telemedicine has gained increased popularity in both medicine and surgery, affording surgeons greater opportunities for patient care, mentoring, collaboration, and teaching, without the limits of geographic boundaries. Telemedicine can be broadly described as a health care service utilizing telecommunication technologies for the purpose of communicating with and diagnosing and treating patients remotely.^1-4 To date, literature on telemedicine in surgical care has been limited.