RESUMEN
INTRODUCTION: Telehealth has become mainstream during the COVID-19 pandemic, but its role in managing older patients is not well defined. This systematic review aims to assess the postoperative benefits of perioperative telehealth interventions in older adults. METHODS: PubMed, Cochrane, and Embase databases were searched through October 2020. Two separate reviewers screened s from the search. Studies were included in the final list if they measured outcomes of telehealth interventions in the perioperative period for patients > 65 years old. Disagreements were settled by a third reviewer, and results were compiled from the final list of articles. Due to heterogeneity, a meta-analysis was not pursued. RESULTS: The search yielded a total of 770 s. Five were included in the review, three randomized and two prospective pilot projects with a collective total of 395 patients. Four studies found that there was a postoperative benefit following perioperative telehealth interventions. Specifically, the interventions improved subjective perceptions of recovery and symptom severity. Though not statistically significant, patients in all included studies had improvements in physical functioning. There was a consistent pattern of steady improvement from baseline in all health areas in older patients. A notable limitation in one study was that participants experienced technical difficulties and required ongoing technical support. CONCLUSION: Perioperative telehealth interventions in older adults can lead to improved clinical outcomes, but existing data are limited. More studies are needed to evaluate the application of telehealth to older adults with frailty, whose ability to participate in the technology may be limited.
RESUMEN
INTRODUCTION: The COVID-19 pandemic stimulated a national lockdown in the UK. The public were advised to avoid unnecessary hospital attendances and health professionals were advised to avoid aerosol-generating procedures wherever possible. The authors hypothesised that these measures would result in a reduction in the number of patients presenting to hospital with acute appendicitis and alter treatment choices. METHODS: A multicentred, prospective observational study was undertaken during April 2020 to identify adults treated for acute appendicitis. Searches of operative and radiological records were performed to identify patients treated during April 2018 and April 2019 for comparison. RESULTS: A total of 190 patients were treated for acute appendicitis pre-lockdown compared with 64 patients treated during lockdown. Patients treated during the pandemic were more likely to have a higher American Society of Anesthesiology (ASA) score (p = 0.049) and to have delayed their presentation to hospital (2 versus 3 days, p = 0.03). During the lockdown, the use of computed tomography (CT) increased from 36.3% to 85.9% (p < 0.001), the use of an antibiotic-only approach increased from 6.2% to 40.6% (p < 0.001) and the rate of laparoscopic appendicectomy reduced from 85.3% to 17.2% (p < 0.001). The negative appendicectomy rate decreased from 21.7% to 7.1% during lockdown (p < 0.001). CONCLUSIONS: The COVID-19 lockdown was associated with a decreased incidence of acute appendicitis and a significant shift in the management approach. The increased use of CT allows the identification of simple appendicitis for conservative treatment and decreases the negative appendicectomy rate.