ABSTRACT
Introduction: The coronavirus (COVID-19) pandemic has presented healthcare workers with one of the most significant global health crises to date. Prior studies have not identified an increase in complications or readmissions in COVID-19 negative patients undergoing emergency or essential surgery during the pandemic. Similar findings have been found in the urgent and elective surgery population. However, no study has shown the risks of all spine surgeries during this time period. Therefore, the purpose of this study is to measure the rates of complications and readmissions for all patients who underwent spine procedures (elective, urgent, and emergent) since the beginning of the COVID-19 pandemic compared to historical averages. Material and Methods: A retrospective review was performed on patients who underwent any spine procedure performed by one of our fellowship-trained spine surgeons at a single tertiary academic center from January 1st, 2019 to June 22nd, 2021. Patients were split into Pre-COVID or Post-COVID cohorts based on the timing of their surgery. March 23, 2020 was designated as the bifurcation based on the first issuance of a Stay at Home Order for COVID-19 in our city. Inpatient complications, 90-day readmission, and inpatient mortality were compared between the two cohorts. Secondary analysis included multiple logistic regression to determine independent predictors of inpatient complications, 90-day readmission, and inpatient mortality. Results: A total of 2,978 patients were included in the final analysis with 1,702 patients receiving designation as Pre-COVID and 1,276 as Post-COVID. The two groups differed with regards to lower Elixhauser scores (1.47 vs 1.65, p = 0.001), lower preoperative diagnoses of stenosis (57.8% vs 62.5%, p = 0.010) and radiculopathy (23.7% vs 31.2%, p < 0.001), fewer revision surgeries (16.8% vs 21.9%, p < 0.001), and fewer patients discharged home (84.5% vs 88.2%, p = 0.011) in the Pre-COVID cohort. The two cohorts had similar inpatient complications (36.6% vs 36.3%, p = 0.893) and inpatient mortality (0.1% vs 0.2%, p = 0.193). The Post-COVID cohort had fewer 90-day readmission (6.1% vs 3.9%, p = 0.008). On regression, being a Post-COVID patient was an independent predictor of decreased 90-day readmission (OR 0.63, p = 0.011). Similarly, surgery in the cervical region was associated with decreased readmission (ref: lumbar, OR 0.28, p = 0.001). Elixhauser (OR 1.12, p = 0.032), fusion surgeries (ref: decompression, OR 1.80, p = 0.027), and being discharged to an inpatient rehab facility (ref: home, OR 1.87, p = 0.021) were all associated with increased 90-day readmissions. Age (OR 1.01, p = 0.036), female sex (OR 1.33, p = 0.001), Elixhauser (OR 1.11, p < 0.001), length of stay (OR1.24, p < 0.001), anterior approach (ref: posterior, OR 2.33, p < 0.001), and combined approach (ref: posterior, OR 1.52, p < 0.001) were independent predictors of increased inpatient complications. Conclusion: Since COVID-19, patients undergoing spine surgery have an increased number of medical comorbidities, but a similar rate of inpatient complications and mortality. Patients are also being readmitted less frequently during the COVID-19 pandemic.
ABSTRACT
Purpose : To compare patient satisfaction for telemedicine visits to traditional in-person clinical visits during the COVID-19 pandemic in the Ophthalmology Department at Boston Medical Center (BMC), the largest academic safety-net hospital in New England. Methods : Patient satisfaction surveys using the NRC Health platform were sent to all patients in their preferred language following eye clinic visits at BMC from June to October 2020. Three visit types were studied: 1) virtual visits via telephone or video conferencing, 2) hybrid visits with protocol-driven set of undilated imaging (e.g. OCT, fundus photos, visual fields), visual acuity, and intraocular pressure obtained by a trained technician, followed by a virtual visit with the physician within 1-2 weeks, and 3) traditional in-person visits. Twotailed Student's t-test was used to compare survey responses of telemedicine to traditional visits in 4 questions: 1) trust in provider (4-point scale, trust), 2) felt provider listened (4- point scale, listened), 3) satisfied with amount of time spent with provider (4-point scale, time), and 4) recommend provider to other patients (10-point scale, recommend). Additionally, responses between English and non-English speakers, requiring trained interpreter services, were compared. Results : A total of 793 visits were included (44 virtual, 56 hybrid, 693 traditional). The majority of telemedicine visits were from the retina and optometry services (Figure 1). There was no statistically significant difference in trust, listened, time, or recommend when comparing virtual or hybrid visits to traditional visits (Table 1a). NonEnglish speakers had statistically significant lower scores in trust, listened, and time with no difference in recommend when compared to English speakers (Table 1b). When stratified by visit type, non-English speakers had a trend towards a lower score in trust for both virtual and hybrid groups. Conclusions : Telemedicine provides patients access to clinical care with decreased risk of infection during the COVID-19 pandemic. Non-English speakers tended to have less trust in the physician for all visit types, which should be considered when communicating with patients. Overall, we found that patients were equally satisfied with telemedicine visits as with traditional in-person visits in a hospital-based academic eye clinic.