Virtual Post-Discharge Follow-Up Visits Work for Low-Risk Surgeries

By Megan Brooks

January 19, 2021

NEW YORK (Reuters Health) - Virtual follow-up visits work well for patients who have had minimally invasive appendectomy or cholecystectomy, new research indicates.

"Post-discharge video-based virtual visits did not increase hospital encounter proportions and provided shorter overall time commitment but equal time with the surgical team member," report Dr. Caroline Reinke with Carolinas Medical Center in Charlotte, North Carolina, and colleagues in JAMA Surgery.

They hope the findings will help surgeons and patients feel more confident in using video-based virtual visits in the time of COVID-19 and beyond.

"Health providers can use this data in their discussions with patients to provide reassurance that virtual visits do not contribute to increased utilization of care and do not result in less time being spent with the clinician," Dr. Reinke told Reuters Health by email.

"Health providers can also be reassured that virtual visits do not increase the amount of time the clinician spends with the patient. We believe these study findings will be especially valuable in the setting of rapid uptake of telemedicine in the setting of COVID-19," Dr. Reinke added.

In a noninferiority trial of adults who underwent minimally invasive appendectomy or cholecystectomy, the researchers randomized 289 patients to a virtual post-discharge visit and 143 to an in-person visit.

The study protocol allowed patients in the virtual-visit group to switch to an in-person office visit for unresolved technical problems; inability to perform full evaluation; need/request for prescription pain medication; malignant neoplasm on pathology; or additional care advised by physician. Other reasons for crossover included patient request and scheduling conflicts. A total of 53 patients did crossover to the in-person follow-up group.

There was no significant difference in the primary outcome of the percentage of patients who had a hospital encounter 30 days after surgery (12.8% for virtual vs. 13.3% for in-person visits).

There was also no difference in the amount of time patients spent with the clinician (mean of 8.4 minutes virtual vs. 7.8 minutes in-person), but the median overall postoperative visit time was 27.5 minutes shorter with the virtual visit, a significant difference.

"Virtual visits eliminated travel time and significantly decreased wait time for post-discharge appointments but did not decrease the amount of time patients were able to spend with the surgery team member," the authors note in their article.

"Although we did not reach target enrollment, noninferiority was demonstrated for post-discharge virtual visits in our study sample and was further supported via a simulation model," they add.

Despite not reaching target enrollment, this study remains the largest randomized controlled trial of video-based virtual visits in general-surgery patients, they say.

"These results can inform future policy decisions regarding use of video-based telehealth in surgical patients," they conclude.

SOURCE: JAMA Surgery, online January 13, 2021.