Use of Telehealth for Routine Postoperative Care in a Safety-Net Population

Abstract

Introduction: Perceived barriers have historically limited telehealth to high-income settings. The COVID-19 pandemic necessitated changes in surgical care, including expanded telehealth access. This study aims to evaluate telehealth’s use for routine postoperative care at an urban safety-net hospital. We hypothesized that completion rates for telehealth would be higher than in-person follow-up, with no difference in the rate of complications. Methods: We performed a retrospective chart review of 410 patients undergoing inguinal hernia repair, appendectomy, cholecystectomy, and lipoma excision, from September 2019 to September 2020. We compared demographics, social determinants of health, co-existing conditions, and appointment completion between in-person and telehealth follow-ups, using univariate methods. Outcomes of interest were 90-day complications, 30-day surgery-related Emergency Department visits, and readmissions and reoperations. Results: Review identified 115 appendectomies, 168 cholecystectomies, 119 inguinal hernia repairs, and 10 lipoma excisions, with 54.4% urgent/emergent. Overall, 84.9% of surgical follow-ups were completed. Preliminary results from patients who underwent appendectomy showed that 15.6% of patients had telehealth and 55.1%in-person postoperative visits. Interpreters were required for 48.7% of patients, 31.3% had a primary care provider at the time of surgery, and 23.5% had unstable housing. The no-show rate for telehealth was 17.6%, compared to 11.7% for in-person visits (p=0.5). The NSQIP-predicted risk of complication was 4.0% in the telehealth and 4.1% in the in-person group;observed complication rates were11.8% for telehealth and 5.0% for in-person follow-up (n=8, p=0.3). Conclusion: In a safety-net population, preliminary results suggest similar rates of visit completion and complication for routine postoperative telehealth. [Formula presented]