Readmission Rates Similar After Virtual, In-Person Postop Cancer Care

Using telehealth for postoperative visits did not increase the risk of readmission when compared with in-person postoperative visits following inpatient cancer surgery, according to a recent study.

Published in JCO Oncology Practice, the study includes data for 535 patients who underwent non-emergency inpatient cancer surgeries at the University of Texas MD Anderson Cancer Center from March 1, 2020, through Dec. 31, 2020. The primary outcome was unplanned hospital readmission within 90 days. Secondary outcomes included 30-day readmission, length of stay of the first readmission, and mortality rates. Researchers considered any unscheduled hospital admission after surgery a "readmission."

Of the 535 patients, 98 (18.5 percent) had an initial postoperative visit via telehealth. White patients were more likely to use telemedicine for postoperative visits compared with non-White patients.

Overall, 60 patients (11.2 percent) were readmitted within 90 days of discharge. Researchers found no difference in 90-day readmission rates for patients with in-person (16.3 percent) versus telemedicine postoperative visits (16.5 percent).

Though there was a slight difference in 30-day readmission rates among patients who had in-person (11.4 percent) and telemedicine postoperative visits (7.1 percent), there were no differences in 90-day mortality or length of stay during readmission between patients in the two groups.

"Telemedicine POV was not associated with readmission risk at 30 and 90 days," researchers concluded. "Factors associated with readmission were perioperative factors such as longer LOS following the index operation and higher Charlson comorbidity score. After adjustment for these and other surgical risk factors such as age, type of operation, and minority status, telemedicine POV was not associated with increased readmission risk."

Further, the median time to readmission was similar between visit types — 17 days after an in-person postoperative visit versus 21 days after a telemedicine visit.

But researchers did observe a difference in the reasons for readmission after in-person and telehealth-based postoperative visits.

The most common reason for readmission after an in-person visit was an anastomotic leak or pancreatic fistula resulting in an abscess. On the other hand, the most common reason for readmission after a telemedicine visit was superficial wound infection.

The researchers noted several limitations to the study, including the retrospective design, which may introduce selection bias toward telemedicine postoperative visits for lower-complexity follow-ups "in ways we were unable to measure from the data collected," they said.

"However, this study does provide real-world evidence to support the use of telemedicine for [postoperative visits] in patients undergoing higher-risk, inpatient major cancer surgery," researchers stated.

Though cancer care specialists agree telehealth can help ensure continued access to care for cancer patients, some gaps need to be mitigated.

A study published last November shows that 66.9 percent of patients in the highest socioeconomic status index quartile had a virtual visit within 30 days of cancer diagnosis, compared with about 48 percent of patients in the lower index quartiles.

Further, low-income, older, and Black cancer patients are less likely to engage in video-based telehealth, another recent study shows.