ABSTRACT
INTRODUCTION: The COVID-19 pandemic facilitated telehealth adoption. Multiple barriers may impact accessibility to such services. We estimated the association between sociodemographic and clinical factors, with keeping telehealth appointments. METHOD(S): Single-center retrospective cohort study comprising consecutive telehealth appointments at the Division of Colorectal Surgery (March-December 2020). Demographics, appointment type, diagnosis, and distance to the hospital were collected. Federal Financial Institutions Examination Council's (FFIEC) website was used to obtain estimated family income and poverty levels based on home location. Multivariable clustered logistic regression estimated the association between sociodemographic characteristics and keeping telehealth appointments. RESULT(S): A total of 925 telehealth appointments were analyzed, of which 84.11% were kept. Non-White patients (odds ratio [OR] 0.59, 95% CI 0.39-0.90, p = 0.015), and those with follow-up appointments (OR 0.50, 95% CI 0.31-3.07, p = 0.006) had lower odds of keeping appointments when compared with White patients, and those having postoperative appointments, respectively. Patients who had attended college had higher odds of keeping appointments (OR 1.77, 95% CI 1.02-3.07, p = 0.044) when compared with those who declined to provide their education level (Figure 1). Age, sex, diagnosis, income level, and percentage of people living under poverty within census tracts per FFIEC were not predictors of keeping telehealth appointments. CONCLUSION(S): Patients self-identifying as non-White and presenting for non-postoperative follow-up visits were more likely to miss telehealth appointments. College education was associated with keeping appointments. Future studies could characterize barriers to telehealth programs implementation to optimize access among groups at high risk of non-compliance. (Figure Presented).
ABSTRACT
Purpose/Background: The emergence of COVID-19 prompted a rapid overhaul of established practice patterns including the implementation of remote perioperative care and delay of non-urgent cases. While these changes were made with the best intentions, limited to no data supports their adoption and as such, it is critical to evaluate surgical outcomes during this period to determine best practices moving forward. Methods/Interventions: We conducted a retrospective review patients undergoing either colectomy or proctectomy within the division of colorectal surgery at a single academic medical center in an area significantly impacted by COVID-19 beginning in March 2020. We compared patients undergoing surgery in the year proceeding COVID-19 “Pre-COVID” and the subsequent 4 months “COVID-era”. The primary outcome was major postoperative complication comprised of postoperative leak, dehiscence, reoperation, death, or major medical complication. Secondary outcomes included length of stay (LOS), readmission, and remote health participation. Multivariable analysis was used to adjust for confounders. Results/Outcome(s): Patient age, gender, race, obesity and frailty rates as well as preoperative diagnosis (neoplastic, inflammatory, or benign) were similar between the Pre-COVID group (n=342) and COVIDera group (n=104). The COVID-era group had a significantly higher percentage of patients with serious systemic disease (57% vs 46% p=0.05), emergency operations (8% vs 3% p=0.05), and pre-operative sepsis or shock (7% vs 2% p=0.03). Major postoperative complication rates were not significantly higher in the COVID group (16% vs 11% p=0.11);however readmission rates were elevated (18% vs 8% p<0.01). After adjustment, emergency case status (OR 7.1 [2.6-19.3]) but not surgery during the COVID-era (OR 1.4 [0.8-2.8]) was associated with major complication. Of the patients being readmitted, those in the COVID-era were less likely to have a primary complaint of ileus or nausea and vomiting (5% vs 23%) and more likely to be readmitted for bleeding (32% vs 8%). Median postoperative LOS was 3 days in both groups. Among the COVID era patients approximately one-half of patients had traditional “in-person” perioperative visits. One-third of patients had remote visits and the remainder were seen in atypical “in-person” encoun-ters such as the emergency department or upon readmission. Conclusions/Discussion: Colorectal surgery patients in the COVID-era were more likely to have an acute presentation requiring emergency surgery but were not at elevated risk for major complication after adjustment for presentation. The implementation of COVID-era practice changes did not compromise the delivery of surgical care although the pattern of readmission was affected.
ABSTRACT
Purpose/Background: Due to the COVID-19 pandemic, the use of telemedicine in surgery is evolving rapidly. However, limited data is available about the feasibility and acceptability of telemedicine visits for routine colorectal complaints. We aim to evaluate the acceptability of telemedicine visits for pre- and postoperative consultation in colorectal clinic. Methods/Interventions: A convenience sample was obtained via recruitment by three colorectal surgeons during routine telemedicine consultation using both phone and video visits from 05/08/20-09/10/20. Patients who chose to participate completed an anonymous survey assessing satisfaction using the Telemedicine Satisfaction Questionnaire. Results/Outcome(s): 111 patients agreed to participate;median age was 49 years (IQR: 33-62 years), 78% were White, 55% female and 57% had private insurance. More than half (54%) were new visits, with 32% postoperative and 25% other follow-up. Most common reason for telemedicine visit was benign anorectal disease. 47 patients (42.3%) completed the questionnaire. The majority of patients were satisfied with telemedicine services: 85% felt comfortable using the technology, 91% reported clear communication and felt their provider understood their concerns, 87% reported saving time, and 89% would use the telemedicine services again. However, only 42% felt that they obtained better access to care via telemedicine. Conclusions/Discussion: Telemedicine allows us to decrease in-person exposure and risk, such as that due to COVID, while maintaining majority positive feedback from patients. Patients report satisfaction with the use of telemedicine, citing convenience and acceptability of technology as factors promoting its use, but fewer than half reported telemedicine to be superior to routine, in-person care. Ongoing evaluation of the quality and delivery of telemedicine should focus on investigating patient satisfaction with delivery mode (i.e. video vs. phone) and identifying which colorectal chief complaints are optimal to be evaluated via telehealth.