The safety of telemedicine clinics as an alternative to in-person preoperative assessment for elective laparoscopic cholecystectomy in patients with benign gallbladder disease: a retrospective cohort study

The safety of telemedicine clinics as an alternative to in-person preoperative assessment for elective laparoscopic cholecystectomy in patients with benign gallbladder disease: a retrospective cohort study

Background The telemedicine clinic for follow up after minor surgical procedures in general surgery is now ubiquitously considered a standard of care. However, this method of consultation is not the mainstay for preoperative assessment and counselling of patients for common surgical procedures such...

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Published in:Patient safety in surgery Vol. 17; no. 1; pp. 1 - 23
Main Authors: Urbonas, Tomas, Lakha, Adil Siraj, King, Emily, Pepes, Sophia, Ceresa, Carlo, Udupa, Venkatesha, Soonawalla, Zahir, Silva, Michael A, Gordon-Weeks, Alex, Reddy, Srikanth
Format: Journal Article
Language:English
Published: London BioMed Central Ltd 29-08-2023
BioMed Central
BMC
Subjects:
Analysis
Cancellation
Cholecystectomy
Cohort analysis
COVID-19
Day case surgery
Elective surgery
Environmental impact
Gallbladder
Gallbladder cancer
Gallbladder diseases
Gallstones
Gastrointestinal surgery
Impact analysis
Laparoscopic cholecystectomy
Laparoscopic surgery
Laparoscopy
Liver
Medical research
Medicine, Experimental
Pandemics
Patient assessment
Patient satisfaction
Patients
Polyps
Preoperative assessment
Safety
Safety and security measures
Subgroups
Surgery
Telemedicine
Telesurgery
Virtual clinics
United Kingdom > UK
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Summary:Background The telemedicine clinic for follow up after minor surgical procedures in general surgery is now ubiquitously considered a standard of care. However, this method of consultation is not the mainstay for preoperative assessment and counselling of patients for common surgical procedures such as laparoscopic cholecystectomy. The aim of this study was to evaluate the safety of assessing and counselling patients in the telemedicine clinic without a physical encounter for laparoscopic cholecystectomy. Methods We conducted a retrospective analysis of patients who were booked for laparoscopic cholecystectomy for benign gallbladder disease via general surgery telemedicine clinics from March 2020 to November 2021. The primary outcome was the cancellation rate on the day of surgery. The secondary outcomes were complication and readmission rates, with Clavein-Dindo grade III or greater deemed clinically significant. We performed a subgroup analysis on the cases cancelled on the day of surgery in an attempt to identify key reasons for cancellation following virtual clinic assessment. Results We identified 206 cases booked for laparoscopic cholecystectomy from telemedicine clinics. 7% of patients had a cancellation on the day of surgery. Only one such cancellation was deemed avoidable as it may have been prevented by a face-to-face assessment. Severe postoperative adverse events (equal to or greater than Clavien-Dindo grade III) were observed in 1% of patients, and required re-intervention. 30-day readmission rate was 11%. Conclusions Our series showed that it is safe and feasible to assess and counsel patients for laparoscopic cholecystectomy remotely with a minimal cancellation rate on the day of operation. Further work is needed to understand the effect of remote consultations on patient satisfaction, its environmental impact, and possible benefits to healthcare economics to support its routine use in general surgery. Keywords: Elective surgery, Day case surgery, Laparoscopic cholecystectomy, Preoperative assessment, Telemedicine, Virtual clinics, Remote healthcare, Telesurgery, General surgery.
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ISSN:1754-9493
1754-9493
DOI:10.1186/s13037-023-00368-7