Variations in Perioperative Telemedicine Use During the COVID-19 Pandemic Without Impact on Postoperative Outcomes

INTRODUCTION: Telemedicine is designed to increase healthcare access. However, its effect on surgical outcomes is not yet known. We aimed to characterize perioperative telemedicine use and determine whether it was associated with postoperative complication. METHODS: Surgical appointments at a tertiary care academic center in Alabama were reviewed from March 1, 2020, to October 4, 2021 (n = 3,207 visits, 1,759 patients). Visits closest to and within 60 days of operation were cross-referenced with institutional American College of Surgeons NSQIP data. t-tests and logistic regression were performed to characterize perioperative telemedicine use and determine associations with postoperative surgical site infection (SSI) and 30-day readmission. RESULTS: Data was available for 1,953 preoperative and 2,054 postoperative visits. Telemedicine was used similarly preoperatively (16.5%) and postoperatively (16.9%, p = 0.8). Telemedicine preoperative visits were closer to operation than in-person (22.2 vs 23.7 days, p = 0.003). Telemedicine postoperative visits were further from operation (27.9 vs 23.7 days, p < 0.001). Preoperative telemedicine visits were more often with general surgery (ref: orthopedic, adjusted odds ratio [aOR]: 4.47, 95% CI: 3.05 to 6.55), for outpatient operation (aOR: 1.84, 95% CI: 1.39 to 2.42), and for lower American Society of Anesthesiologists score patients (aOR: 0.71, 95% CI: 0.54 to 0.94). There was no significant association between telemedicine use and age, race, or BMI. Similar findings existed for postoperative visits. SSI was lower among operations with telemedicine preoperatively (aOR: 0.46, 95% CI: 0.21 to 0.99) and postoperatively (aOR: 0.37, 95% CI: 0.17 to 0.8) without significant association with 30-day readmission. CONCLUSION: Most perioperative appointments are currently in-person, with telemedicine use typically occurring for healthier patients undergoing outpatient operation. Perioperative telemedicine use is not associated with increased SSI or readmission and should be considered as an option to improve surgical access while maintaining quality care.