Telehealth Effective in Providing Preoperative Care for Bariatric Surgery

A recent study published in JAMA Network Open found that when comparing in-person visits to telehealth for providing bariatric surgical preoperative care, one group's clinical outcomes and postoperative hospital utilization did not exceed those of the other.

According to the study, though it is underutilized, bariatric surgery is a typically suggested treatment for medically refractory obesity. Researchers hypothesized that telehealth might provide benefits that could boost bariatric surgery availability and access. Thus, they conducted a study to assess the impact of telehealth-delivered preoperative care for bariatric surgery and how it compares to in-person care.

Specifically, they conducted a cohort study that compared postoperative clinical outcomes and hospital use between two groups who received pre-surgical evaluation through telehealth or in person.

All study participants underwent a laparoscopic Roux-en-Y gastric bypass or a laparoscopic sleeve gastrectomy following preoperative surgical evaluation.

For the telehealth group, the surgeries took place between July 1, 2020, and Dec. 22, 2021, and for the in-person group, they occurred between January 1, 2018, and Dec. 31, 2019.

The total study population included 1,182 patients. Researchers noted that those in the telehealth group tended to be younger and female, and patients in the in-person control group had a higher prevalence of comorbidities.

Researchers used clinical outcomes as the main measure, which included operating room delay, procedure duration, length of stay in the hospital (LOS), and major adverse events (MAE). They also considered postoperative hospital resource utilization, which included emergency department (ED) visits and hospital readmission.

Following evaluation, researchers concluded that the clinical outcomes for the 257 patients in the telehealth group were not inferior to those of the 925 patients in the control group, which indicates telehealth is an effective resource for providing bariatric surgical preoperative care.

For example, the average operating room delay was 7.8 minutes for the control group and 4.2 minutes for the telehealth group. For the control group, the average procedure duration was 134.4 minutes, while it was 105.3 minutes for the telehealth group.

MAEs were also similar between the two groups, with only one death occurring in the control group and zero in the telehealth group.

In addition, there was little difference in the frequency of ED visits and hospital readmission between the two groups.

"Telemedicine may expand the reach of bariatric surgery and narrow disparities for historically disinvested patient populations," the researchers concluded.

However, the study had several limitations, including the single institution setting, retrospective bias, and the potential inaccuracies associated with self-reported weight measurements from the telehealth group during follow-ups.

This is not the first study to indicate that telehealth can be used to provide effective preoperative care.

A study published in October 2021 found that cancer patients who received pre-anesthesia evaluations through telehealth experienced benefits such as saved time and money.

According to the retrospective study conducted by Florida’s H. Lee Moffitt Cancer Center, cancer patients often face frequent travel for lab work, imaging, surgeries, and treatment. These time-sensitive obligations, along with caregiver burdens, such as the need to take time off from work, are often strenuous.

Researchers found that telehealth could be used to conduct pre-anesthesia evaluations, saving patients a median of 121 minutes in travel time and a median of $46 on gas. Further, they observed that the use of telehealth did not impact cancellation rates.