Telemedicine Evaluations Improve Accessibility Without Compromising Results of Bariatric Surgery

Anita Courcoulas, MD

Contrary to the beliefs of many in the field, new research suggests patient evaluations can be done fully remote for people considering bariatric surgery without compromising outcomes or safety.

Results of the study, which compared a fully remote patient evaluation against in-person preoperative surgical evaluation, suggest a fully remote evaluation leveraging telemedicine was not inferior to in-person evaluation for major adverse events or healthcare utilization following bariatric surgery, which leads investigators to purport such an approach could improve accessibility of bariatric surgery and offer patients increased flexibility for preoperative care.¹

“In this cohort study, total preoperative telemedicine in bariatric surgery was associated with noninferior clinical outcomes and hospital utilization compared with traditional, in-person patient care,” wrote investigators.¹ “Telemedicine may expand the reach of bariatric surgery and narrow disparities for historically disinvested patient populations.”

Even with the introduction of GLP-1 receptor agonists into the treatment of obesity, bariatric surgery remains a corner stone of obesity management, with recent data reflecting safety and efficacy of the treatment for decades after a procedure.2 Although the COVID-19 pandemic has brought forth many negative, long-lasting effects on society, a silver lining of the pandemic for healthcare systems has been the rapid uptake and utilization of telemedicine.

In the current study, a team from the University of Pittsburgh led by Anita Courcoulas, MD, sought to examine whether a telemedicine approach to preoperative evaluations for bariatric surgery candidates might influence clinical outcomes and hospital utilization following surgery. With this in mind, investigators designed their research endeavor as a single-institution, retrospective, noninferiority cohort study of patients who underwent laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy after telemedicine or in-person preoperative surgical evaluation between July 1, 2020-December 22, 2021, or January 1, 2018-December 31, 2019, respectively.¹

Outcomes of interest for the investigators’ analyses included operating room delay, procedure duration, length of hospital stay (LOS), major adverse events, and postoperative hospital resource utilization, including emergency department visit or hospital readmission within 30 days of the surgical procedure.

Overall, 1182 patients were identified for inclusion in the study. Of these, 925 underwent an in-person evaluation and 257 underwent a telemedicine evaluation. Compared to their counterparts who underwent in-person evaluations, those in the telemedicine group were younger (mean [SD] age, 40.8 [12.5] years vs 43.0 [12.2] years; P=.01) and more likely to be female (89.5% vs 82.8%; P=.01). However, investigators noted those who underwent in-person preoperative evaluations had a higher frequency of comorbidity than those in the telemedicine group (95.9% vs 80.9%; P <.001).¹

Upon analysis, results demonstrated a preoperative evaluation performed using telemedicine was non inferior to in-person preoperative evaluation for operating room delay (mean minutes, 7.8 [25.1]; 95% CI, 5.1-10.5 vs 4.2 [11.1]; 95%CI, 1.0-7.4; P=.002), procedure duration (mean minutes, 134.4 [52.8]; 95% CI, 130.9-137.8 vs 105.3 [41.5]; 95% CI, 100.2-110.4; P <.001), LOS (mean days, 1.9 [1.1]; 95% CI, 1.8-1.9 vs 2.1 [1.0]; 95% CI, 1.9-2.2; P <.001), major adverse events within 30 days (3.8% [95% CI, 3.0-5.7] vs 1.6% [95% CI, 0.4-3.9; P=.001), major adverse events between 31-60 days (2.2% [95% CI, 1.3-3.3] vs 1.6% [95% CI, 0.4-3.9]; P <.001), frequency of emergency department visits (18.8% [95% CI, 16.3-21.4] vs 17.9% [95% CI, 13.2-22.6]; P=.03), and hospital readmission (10.1% [95% CI, 8.1-12.0] vs 6.6% [95% CI, 3.9-10.4]; P=.02).¹

“To our knowledge, this study was one of the largest cohorts of patients undergoing bariatric surgery after total telemedicine preoperative care. We found that postoperative clinical outcomes and hospital utilization for patients undergoing bariatric surgery after exclusively telemedicine-based preoperative evaluation are noninferior to patients receiving traditional, in-person care,” investigators wrote.¹ “The advantages of telemedicine with regards to patient cost and time savings may facilitate accessibility to bariatric surgery, especially for the underserved.”

References:

1. Courcoulas A, Ahmed B, Kaynar M, et al. Clinical Outcomes and Hospital Utilization Among Patients Undergoing Bariatric Surgery With Telemedicine Preoperative Care. JAMA Network Open. February 2023. doi:DOI: 10.1001/jamanetworkopen.2022.55994
2. Campbell P. Comprehensive study, boasting 40 years of follow-up, underlines long-term benefits of bariatric surgery. HCP Live. https://www.hcplive.com/view/study-40-years-follow-up-long-term-benefits-of-bariatric-surgery. Published January 25, 2023. Accessed February 10, 2023.