ABSTRACT
BACKGROUND CONTEXT This pandemic has further shifted medicine toward a reliance and adoption of technology with a steep learning curve. The pandemic created a need to interact with patients without immediate in-person contact. Due to the COVID-19, our division transitioned from 0% telehealth visits (TV) to 100% TV in the matter of 1-2 weeks. The inexperience of patients and providers with TV could potentially impact the quality of care for spine patients. Further insight is required to determine how effective this mode of care is for spine surgeons. PURPOSE To evaluate the efficacy of TV as a modality of treatment in spine surgery. STUDY DESIGN/SETTING Single-center retrospective cohort study. PATIENT SAMPLE This study included 85 patients (43 TV only and 42 with TV and OV). OUTCOME MEASURES Patient demographics, treated pathologies, changes in diagnosis, updated MRI imaging, and changes in surgical plans. METHODS Included: patients undergoing spinal surgery who received either a TV-only or TV and an office visit (OV) prior to surgery post-March 2020. Excluded: patients who received TV and OV by two separate providers, providers outside of the spine service, or patients with an initial OV in the time frame. The cohort was separated into patients who only had a TV or had an initial TV and subsequent OV (TV+OV) prior to surgery. The rates of patients scheduled for surgery through TV alone vs TV and in-person visit were analyzed. Changes in diagnosis and surgical plans from in-person vs telehealth were assessed. Relationships between spine pathologies treated and efficacy of the TV alone were established using chi-squared analyses (α=0.05). RESULTS A total of 85 patients (43 TV-only and 42 with TV+OV) met these criteria. There is no significant difference in age, gender, BMI, and patient status between patients with TV-only (age: 55.7±15.6, % female: 47%, BMI: 27.0±4.8, and % new patients: 16.3%) and those with both TV and OV (age: 55.4±15.3, p=0.919;% female: 55%, 0.453;BMI: 28.9±5.9, p=0.122;% new patients: 33.3%, p=0.220). TV-only had significantly more patients treated for cervical or lumbar radiculopathy than those with both OV+TV (69.8% vs 57.1%, p=0.003). TV-only had a significantly higher percentage of patients that have MRIs prior to their visit than those with both TV and OV (95.8% vs 76.2%, p<0.001). Of total patients, 11.9% with both TV and OV had a change in surgical plans from the initial TV to the subsequent OV. The cases with changes in surgical plans were all associated with updated imaging. CONCLUSIONS With TV-alone, common spine pathologies are identifiable through history, TV physical examination, and advanced imaging. Although TV seemed concordant with OV in times of emergency, the authors recommend confirmation of the examination prior to undertaking operative procedures. Further insight in the outcomes of the procedures with TV only and TV+OV can be compared through change in PROMIS from baseline to 1 year. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
ABSTRACT
BACKGROUND CONTEXT: The COVID-19 pandemic caused nationwide suspensions of elective surgeries due to reallocation of resources to the care of COVID-19 patients. Following resumption of elective cases, a significant proportion of patients continued to delay surgery, with many yet to reschedule, potentially prolonging their pain and impairment of function and causing detrimental long-term effects. PURPOSE: The aim of this study was to examine differences between patients who have and have not rescheduled their spine surgery procedures originally cancelled due to the COVID-19 pandemic, and to evaluate the reasons for continued deferment of spine surgeries even after the lifting of the mandated suspension of elective surgeries. STUDY DESIGN/SETTING: Retrospective case series at a single institution PATIENT SAMPLE: Included were 133 patients seen at a single institution where spine surgery was canceled due to a state-mandated suspension of elective surgeries from March to June, 2020. OUTCOME MEASURES: The measures assessed included preoperative diagnoses and neurological dysfunction, surgical characteristics, reasons for surgery deferment, and PROMIS scores of pain intensity, pain interference, and physical function. METHODS: Patient electronic medical records were reviewed. Patients who had not rescheduled their canceled surgery as of January 31, 2021, and did not have a reason noted in their charts were called to determine the reason for continued surgery deferment. Patients were divided into three groups: early rescheduled (ER), late rescheduled (LR), and not rescheduled (NR). ER patients had a date of surgery (DOS) prior to the city's Phase 4 reopening on July 20, 2020; LR patients had a DOS on or after that date. Statistical analysis of the group findings included analysis of variance with Tukey's honestly significant difference (HSD) post-hoc test, independent samples T-test, and chi-square analysis with significance set at p≤.05. RESULTS: Out of 133 patients, 47.4% (63) were in the ER, 15.8% (21) in the LR, and 36.8% (49) in the NR groups. Demographics and baseline PROMIS scores were similar between groups. LR had more levels fused (3.6) than ER (1.6), p= .018 on Tukey HSD. NR (2.1) did not have different mean levels fused than LR or ER, both p= >.05 on Tukey HSD. LR had more three column osteotomies (14.3%) than ER and (1.6%) and NR (2.0%) p=.022, and fewer lumbar microdiscectomies (0%) compared to ER (20.6%) and NR (10.2%), p=.039. Other surgical characteristics were similar between groups. LR had a longer length of stay than ER (4.2 vs 2.4, p=.036). No patients in ER or LR had a nosocomial COVID-19 infection. Of NR, 2.0% have a future surgery date scheduled and 8.2% (4) are acquiring updated exams before rescheduling. 40.8% (20; 15.0% total cohort) continue to defer surgery over concern for COVID-19 exposure and 16.3% (8) for medical comorbidities. 6.1% (3) permanently canceled for symptom improvement. 8.2% (4) had follow-up recommendations for non-surgical management. 4.1% (2) are since deceased. CONCLUSION: Over 1/3 of elective spine surgeries canceled due to COVID-19 have not been performed in the 8 months from when elective surgeries resumed in our institution to the end of the study. ER patients had less complex surgeries planned than LR. NR patients continue to defer surgery primarily over concern for COVID-19 exposure. The toll on the health of these patients as a result of the delay in treatment and on their lives due to their inability to return to normal function remains to be seen.