Telemedicine Just as Good as In-Person Presurgical Care for Bariatric Procedures

Patients undergoing bariatric surgery who received their preoperative care via telemedicine had similar clinical outcomes to those who had in-person care, a cohort study showed.

Among nearly 1,200 patients, telemedicine was found to be noninferior to in-person care for the following clinical outcomes and postoperative hospital resource utilization:

• Operating room delay: mean 7.8 vs 4.2 minutes (P=0.002)
• Procedure duration: mean 134.4 vs 105.3 minutes (P<0.001)
• Length of hospital stay: mean 1.9 vs 2.1 days (P<0.001)
• Major adverse events: 3.8% vs 1.6% within 30 days; 2.2% vs 1.6% within 31-60 days (P<0.001 for both)
• Emergency department visits within 30 days: 18.8% vs 17.9% (P=0.03)
• Hospital readmission within 30 days: 10.1% vs 6.6% (P=0.02)

Only one patient death was reported in the in-person group, which occurred within 30 days of surgery, reported Callie Hlavin, MD, of the University of Pittsburgh, and colleagues in JAMA Network Open.

Of note, the in-person group had a higher frequency of comorbidities at baseline compared with the telemedicine group (95.9% vs 80.9%), including obstructive sleep apnea (70.1% vs 28.5%), hypertension (48.4% vs 35%), gastroesophageal reflux disease (46.5% vs 31.1%) dyslipidemia (31.5% vs 20.2%), type 2 diabetes (18.9% vs 8.6%), and anxiety or depression (54% vs 42%).

“The advantages of telemedicine with regards to patient cost and time savings may facilitate accessibility to bariatric surgery, especially for the underserved,” Hlavin and team wrote. “Telemedicine may expand the reach of bariatric surgery and narrow disparities for historically disinvested patient populations.”

“While bariatric surgery is safe, effective, and economical, it is considerably underutilized,” they added. “Less than 1% of eligible patients with obesity undergo bariatric surgery, despite the widely encompassing referral criteria for adults laid forth by the National Institutes of Health.”

Among the 1,182 patients included in the single-center study, 708 underwent laparoscopic Roux-en-Y gastric bypass and 474 underwent laparoscopic sleeve gastrectomy.

More gastric bypass patients had in-person preoperative evaluations (61.7% vs 53.3%), which took place from January 2018 through December 2019, while more sleeve gastrectomy patients had evaluations done over telemedicine (46.7% vs 38.3%), which took place from July 2020 through December 2021.

Nearly all patients who had a presurgical evaluation done over telemedicine had private insurance. As for those with in-person evaluations, patients had a mix of private insurance (64%), Medicare (16.9%), Medicaid (6.8%), or no insurance (9.2%).

Telemedicine patients were also more likely to be women (89.5% vs 82.8%) and younger (mean age 40.8 vs 43).

Telemedicine visits were video-based and were performed by a combination of surgical attending physicians, fellows, residents, advance practice clinicians, and nurses.

“Further investigations should focus on geographical differences between telemedicine and traditional, in-person patient populations and ensure both patient and clinician satisfaction,” Hlavin and colleagues wrote. “In addition, the total telemedicine design should be studied prospectively to identify patient and provider barriers to its use. Future implementation and dissemination may be beneficial in other surgical fields.”

They noted that since their study was conducted at a single center, generalizability may be limited. The retrospective nature of the study may also have introduced unintended bias.