Outcomes for audio-only and video-based preoperative encounters for abdominal wall reconstruction and hernia consultations.

BACKGROUND: Digital health is commonly utilized for surgical evaluation, however little is known regarding the relative effectiveness of audio-only and video-based encounters. METHODS: A retrospective analysis of all patients undergoing preoperative digital health encounters at a hernia center from March 2020-May 2021 was conducted. Visit types were dichotomized to audio-only and video-based encounters. Downstream care utilization and visit-specific outcomes were analyzed. RESULTS: 204 preoperative digital health encounters were conducted during the study period. Audio-only encounters were more commonly performed for patients classified as older and rural. Supplemental in-person examinations were required among 13.5% and 4.0% of new- and established-patient encounters, respectively, with no significant difference between audio-only and video-based assessments. Finalized operative plans were coordinated for 43.6% of patients, with no significant difference among groups. CONCLUSIONS: Patients being evaluated with audio-only encounters are more likely to be older and reside in rural settings, yet demonstrate no significant difference in downstream care utilization and clinic encounter outcomes relative to those being evaluated via video-based assessment. Enabling audio-only surgical consultations may minimize disparities in digital care.

A National Evaluation of Surgeon Experiences in Telemedicine for the Care of Hernia and Abdominal Core Health Patients.

BACKGROUND: Surgeons are increasingly utilizing telemedicine to provide perioperative services to patients. Safety, satisfaction, and feasibility of these programs in general populations have been established, but it is unclear how telemedicine can be integrated into subspecialty care. We report results of a national survey related to telehealth practices among members of the Abdominal Core Health Quality Collaborative (ACHQC). METHODS: Survey responses were analyzed to determine current strategies in telemedicine utilization. Surgeon preferences, perceptions of validity, and identified barriers to implementation of telemedicine were assessed. RESULTS: Forty surgeons within the ACHQC responded, with 90% of respondents reporting use of telemedicine to deliver perioperative care to patients with hernias and abdominal core health concerns. Surgeons appeared to be more comfortable managing preoperative patients with image-confirmed diagnoses of hernias. Surgeons were universally more comfortable delivering postoperative care via telemedicine. Connectivity, patient engagement, and reimbursement were identified as potential barriers to expansion of telemedicine. Seventy-eight percent of respondents reported that they would increase telemedicine utilization if current regulations were maintained in the future. CONCLUSIONS: This study found that hernia specialists are utilizing telemedicine at a higher rate than before the COVID-19 pandemic, with surgeons reporting interest in continued use of this modality beyond the pandemic. These findings suggest that future work in telemedicine optimization may improve the quality of care that can be delivered to patients with abdominal core health concerns.

Current Surgical Trainee Perceptions and Experiences in Telehealth.

Introduction:Broad expansion of telehealth technologies has been implemented during the coronavirus disease 2019 (COVID-19) pandemic to allow for physical distancing and limitation of viral transmission within health care facilities. Although telehealth has been studied for its impact on patients, payors, and practitioners, its educational impact is largely unstudied. To better understand the trainee experience and perception of telehealth during the COVID-19 pandemic, we conducted a survey of the membership of the American College of Surgeons Resident and Associate Society (RAS).Methods:An anonymous survey was sent to members of RAS. Descriptive analysis was used to report experiences and perceptions. Chi-square analysis was used to compare cohorts with and without exposure to telehealth.Results:Of the 465 RAS respondents, 292 (62.8%) reported knowledge of telehealth technologies at their institutions. The majority of these respondents experienced a decrease in in-person clinic volume (94.4%) and an associated increase in virtual clinic volume (95.7%) related to the COVID-19 pandemic. Trainee integration into telehealth workflows increased drastically from prepandemic levels (11% vs. 54.5%, p < 0.001). Likelihood of trainee exposure to telehealth was associated with university-based training programs or larger program size. Trainees demonstrated a desire for more integration and development of curricula.Conclusions:These data serve as the first description of surgical trainee experience with, and opinion of, telehealth. Trainees recognize the importance of their integration and training in telehealth. These results should be used to guide the development of workflows and curricula that integrate trainees into telemedicine clinics.