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• Posted September 20, 2021

Telemedicine Gets High Marks for Follow-Ups After Surgery

After routine surgery, a "virtual" follow-up visit might be just as good as a traditional office appointment, a new study suggests.

Researchers found that surgery patients who had video follow-up appointments were just as satisfied with their care as those who made a trip to the office. And they appreciated the convenience of skipping the commute and the doctor's waiting room.

The pandemic pushed "telemedicine" into the spotlight when, during the height of the pandemic, many medical appointments shifted to online platforms. But telemedicine has been around for years, and the new study was conducted before the pandemic.

Researchers said it adds to evidence that even after surgery, virtual appointments can be all that's needed.

"It's safe, and you're going to get good care," said senior researcher Dr. Caroline Reinke, an associate professor of surgery at Atrium Health Carolinas Medical Center, in Charlotte, N.C. "Both virtual and in-person visits are great options."

There are times, of course, when an old-fashioned visit is necessary, Reinke said -- such as when patients need staples or sutures removed.

All of the patients in the current study underwent either of two fairly simple procedures: minimally invasive removal of the appendix or gallbladder.

"But with COVID we've seen that virtual visits can be expanded to other procedures, too," said study co-author Kristen Harkey, a nurse practitioner at Atrium.

Since the start of the pandemic, she said, more patients and providers have become comfortable with video appointments. "There's definitely been a shift," Harkey said.

The study -- published recently in the Journal of the American College of Surgeons -- involved 289 patients who had appendix or gallbladder surgery between 2017 and March 2020.

They were randomly assigned to have either a video-based or office appointment to see how they were doing post-surgery. Afterward they completed surveys on their experience.

Overall, patients in both groups were equally satisfied with their care. But the virtual group was more likely to opt for the same route again: About 79% said they'd choose virtual for future follow-ups; fewer than half of office patients said they'd choose in-person visits.

Not surprisingly, the virtual group liked the convenience: They avoided the biggest hassles reported by the in-person group -- the commute, finding parking and sitting in the waiting room.

Virtual visits were not always smooth, however. Around 27% of patients faced technical issues, such as difficulty using the platform or unstable internet connections. Another complaint: It was sometimes difficult to schedule an appointment because doctors allot only certain hours to virtual care.

Since the time of the study, Harkey said, the platform has been updated to address those issues.

Dr. Scott Nguyen is a surgeon at Mount Sinai Hospital in New York City. He agreed that with the pandemic, patients and providers have become more comfortable with virtual visits.

And importantly, Nguyen noted, insurance companies have "come around" and are now covering them.

"We're pretty much all doing hybrid appointments now," said Nguyen, who wasn't involved with the study.

Virtual visits, he said, are well-suited to the "one and done" follow-up that's needed after a simple appendix removal, for example.

But with more complex procedures, Nguyen said he wants to have at least one face-to-face visit.

Even in those cases, though, there can be a role for virtual visits. Nguyen performs bariatric (weight-loss) procedures, where patients have multiple follow-up appointments over time; some of those can be done online.

Virtual visits, Nguyen said, have been particularly helpful for giving nutrition counseling after bariatric surgery.

The convenience is an obvious advantage, Nguyen said, noting that many patients have to travel a long distance for office appointments -- which can mean having to take time off from work or finding child care.

Online visits can also work for older adults who have difficulty getting around or rely on family members for transportation, Harkey noted. And while younger people tend to have an easier time with the technology, many older adults are adept, too. Others, she said, get some help from their grandchildren.

Even as comfort with virtual care grows, though, some people simply prefer in-person communication, Nguyen noted.

"Televisits are here to stay, and definitely add a layer of convenience," he said. "But they won't replace face-to-face care."

More information

The U.S. Department of Health and Human Services has more on telemedicine.

SOURCES: Kristen Harkey, DNP, nurse practitioner, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, N.C.; Caroline Reinke, MD, associate professor, surgery, Atrium Health, Charlotte, N.C.; Scott Nguyen, MD, associate professor, surgery, Icahn School of Medicine at Mount Sinai, New York City; Journal of the American College of Surgeons, Sept. 9, 2021, online