Telehealth interventions enhance post-abdominal surgery outcomes

Telehealth-based interventions can help lower the risk of readmissions and emergency department (ED) visits after abdominal surgery, according to new research published in JAMA Network Open.

The study notes that amid the digital healthcare boom of the COVID-19 pandemic, telehealth technologies were applied in areas where they were previously not used, including surgery. Though the use of telehealth in surgery is growing, the study authors noted that there is little research on how telehealth utilization affects patient safety in abdominal surgery.

Thus, the researchers conducted a systematic review and meta-analysis to evaluate whether telehealth-based interventions reduce complications, readmissions, and postoperative ED visits among abdominal surgery patients. They searched PubMed, Cochrane Library, and Web of Science databases from inception through February 2023 to identify randomized clinical trials (RCTs) and nonrandomized studies that compared perioperative telehealth interventions with usual care and reported at least one patient safety outcome.

The researchers included 11 RCTs and eight cohort studies with 10,536 patients in the study. Fourteen (73.7 percent) of the studies were from the United States and Canada), and the remaining five (26.3 percent) were from the United Kingdom, Australia, the Netherlands, Sweden, and Spain.

In the RCTs, 1,946 patients were in the telehealth intervention group, and 1,939 were in the usual care group. The cohort studies included 3,376 patients in the telehealth intervention arm and 3,275 in the usual care arm.

The studies included three types of interventions: telehealth consultations via video or scripted telephone calls; a mobile application that delivered a perioperative recovery program, patient education, follow-up, and health monitoring; and remote monitoring using a telemedicine device.

Of the 19 studies, 11 (57.9 percent) reported postoperative complications. However, there was no significant difference in complication rate between the telehealth and usual care groups.

Eleven studies reported hospital readmission rates; seven RCTs and six cohort studies reported data on ED visits. Researchers found that the telehealth group experienced a reduction in readmission rates and ED visits compared with the usual care group, with low to moderate heterogeneity.

The researchers noted that since various technologies were used in the telehealth interventions across the studies, it is not possible to pinpoint whether one or a combination of the technologies improved post-surgery outcomes.

“…however, this study provided some indications of specific mechanisms that may inform future research,” they wrote. “For instance, the use of mobile applications can reduce the time delays between complication onset and treatment; increase the monitoring of the recovery process (particularly in the first days after hospital discharge); or provide a more informative remote assessment of the patient’s status via pictures, videoconferences, and other media.”

Research backing telehealth use in surgery is expanding; however, surgical specialists remain wary of the care modality.

The 2021 National Electronic Health Records Survey, which polled 10,302 office-based physicians, showed that 49.5 percent of surgical specialists were satisfied with telehealth technology compared to 65.5 percent of primary care physicians and 63.6 percent of medical specialists. Additionally, 49.7 percent of surgical specialists indicated telehealth was inappropriate for their specialty or type of patients.

While telehealth is not suitable for many aspects of surgery, the American College of Surgeons (ACS) recently released a statement highlighting its potential to improve surgical care and outlining standards for its use.

According to the ACS, telehealth empowers patients to play an active role in their healthcare journey and enables support through the continuum of care, from preoperative assessments to postoperative follow-up and survivorship.

The organization detailed best practices for using telehealth in surgery, including that healthcare organizations maintain a technical infrastructure that includes a secure, high-speed internet connection and user-friendly telehealth platform.