Reduction of patient travel and carbon emissions with virtual visits in general surgery

Abstract

Background: In response to the COVID-19 pandemic, telemedicine emerged as an important tool. Few studies have examined the impact of virtual visits in General Surgery. The purpose of our study is to analyze the effect of outpatient virtual visits on surgery patient travel burden and its associated environmental impact at a quaternary academic institution. Methods: The electronic medical record was queried for all outpatient visits with 16 general surgery staff comprised of hepato-pancreato-biliary, acute care surgery, hernia and breast at our institution between 2017-2022. Virtual visits were defined as synchronous surgeon-to-patient interaction through video conferencing platform. Telephone encounters were excluded. Office and virtual visits for the 18 months prior to COVID-19 (July 2017- December 2019) were compared to the 18-month period during COVID-19 (January 2020-June 2022). To estimate travel burden and environmental impact, patients were assumed to travel via an average gasoline-powered passenger vehicle. Travel burden of patients was inferred from distance based on zip codes, and travel cost was estimated using distance traveled, parking costs, fuel economy, and average US retail gasoline prices by year. To estimate carbon emissions, the following assumptions were made: 1) average fuel economy is 24.2 miles per gasoline gallon (US Department of Energy); 2) average carbon emissions are 404 grams of CO2 per mile. Results: A total of 56,248 office and distance health visits were identified. In the pre-COVID period, of 26,515 visits, 26,208 (98.8%) were in-office and 307 (1.2%) were virtual visits. During COVID, of 29,733 visits, 26,477 (89.0%) were in-office and 3,256 (10.9%) were virtual visits. Estimated median and total travel burden and environmental impact of virtual visits are summarized in Table 1. Prior to COVID, office visits cost $631,660 in travel, consumed 194,332 gallons of gasoline, and produced 1,899,949 kilograms of CO2 with a median travel distance of 58 (IQR 18-188) miles. Patients undergoing virtual visits during the same period saved a total of $23,942, 8,345 gallons of gasoline, and 81,590 kilograms of CO2 with a median travel distance saved of 378 (IQR 157-785) miles. In the COVID period, office visits cost $592,786 in travel, consumed 174,290 gallons of gasoline, and produced 1,703,999 kilograms of CO2 for a median travel distance of 54 (IQR 18-164) miles. Patients undergoing virtual visits during the same period saved a total of $147,437, 49,233 gallons of gasoline, and 481,341 kilograms of CO2 for travel a median travel distance saved of 182 (IQR 52-404) miles. There is a difference of 40,888 gallons of gasoline and 399,751 kilogram of CO2 for the two periods. Conclusion: Saving nearly 40,000 gallons of gas and over 400,000 kilograms of CO2 emissions, telemedicine was successfully utilized to maintain clinical volume during COVID-19 while reducing patient travel burden, equivalent to carbon sequestered by 473 acres of US forest in one year. The impact of virtual visits extends beyond the cost of care not only in dollars, but on the environment. Further work is needed to measure quality of care and satisfaction of surgeons and patients to continue integration of virtual visits for select general surgery patients.