6. Telemedicine visits generate accurate surgical plans in spine surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> The role of telemedicine is rapidly evolving in all medical specialties, including orthopedic spine surgery. In particular, the utility of telemedicine to identify operative candidates and to determine surgical plans has yet to be demonstrated. <h3>PURPOSE</h3> The aims of this study were: 1. to assess whether surgical plans proposed following telemedicine visits changed after subsequent in-person evaluation, and 2. to characterize the extent and types of virtual exams performed across providers at 2 tertiary care centers. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study <h3>PATIENT SAMPLE</h3> The clinical registry of Mass General Brigham (MGB) was used to review all telemedicine encounters within the Division of Orthopaedic Spine Surgery between March 1, 2020 and July 31, 2020 and to identify patients who were indicated for elective surgery during their virtual visit. <h3>OUTCOME MEASURES</h3> Patient age, biologic sex, race/ethnicity, indication for visit, orthopedic subspecialty service, indication for surgery, the extent of the virtual physical examination and preoperative surgical plan were recorded. <h3>METHODS</h3> The MGB clinical registry was used to identify patients who were indicated for elective surgery during their virtual visit. The surgical plans delineated during the telemedicine encounter were then compared to final preoperative plans as documented following subsequent in-person evaluation. Virtual physical exams were categorized based on the extent of maneuvers performed and assigned a value ranging from 0 (no exam), to 3 (three or more maneuvers performed). <h3>RESULTS</h3> In total, 59 patients were indicated for surgery with a detailed surgical plan based on virtual visit alone. In 55 of these 59 patients (proportion 0.08, 95% CI 0.03 to 0.19) the surgical plan did not change after in-person evaluation. Inter- and intra-provider virtual exam variability was evident both within and across MGB institutions. <h3>CONCLUSIONS</h3> There is much work to be done to determine how to best leverage the synergies between telemedicine and in-person evaluation for orthopedic spine patients. Here, we have demonstrated the capability of telemedicine to support the development of accurate surgical plans across 2 institutions. Furthermore, this work highlights the substantial variability in the utilization of physical examination maneuvers conducted via telemedicine across institutions and providers. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.