Telemedicine versus face-to-face follow up in general surgery: a randomized controlled trial

Abstract

Background: Telemedicine provides healthcare to patients at a distance from their treating clinician. There is a lack of high-quality evidence to support the safety and acceptability of telemedicine for postoperative outpatient follow-up. This randomized controlled trial-conducted before the COVID-19 pandemic-aimed to assess patient satisfaction and safety (as determined by readmission, reoperation and complication rates) by telephone compared to face-to-face follow-up after uncomplicated general surgical procedures.

Methods: Patients following laparoscopic appendicectomy or cholecystectomy and laparoscopic or open umbilical or inguinal hernia repairs were randomized to a telephone or face-to-face outpatient clinic. Patient demographics, perioperative details and postoperative outcomes were compared. Patient satisfaction was assessed via a standardized Likert-style scale.

Results: One hundred and twenty-three patients were randomized over 12 months. Mean consultation times were significantly shorter for telemedicine than face-to-face clinics (telemedicine 10.52 ± 7.2 min, face-to-face 15.95 ± 9.96 min, P = 0.0021). There was no difference between groups in the attendance rates, nor the incidence or detection of postoperative complications. Of the 58 patients randomized to the telemedicine arm, 40% reported high, and 60% reported very high satisfaction with the method of clinic follow-up.

Conclusion: Telemedicine postoperative follow-up is safe and acceptable to patients and could be considered in patients undergoing uncomplicated benign general surgery.

Keywords: appendicectomy; cholecystectomy; hernia; patient satisfaction; telemedicine.

Fig. 1

CONSORT flow diagram of participant recruitment and progress in this randomized control trial.

Fig. 2

Patient satisfaction survey responses (1 strongly agree to 5 strongly disagree) (x‐axis) from telemedicine and face‐to‐face clinic groups, highlighting the frequency and distribution of scores in each question. Patient survey questions: (a)—You were happy with the timing of the post‐operative review; (b)—The outcome of your surgery was satisfactory; (c)—Your method of postoperative follow‐up was satisfactory; (d)—You would prefer an alternative way of follow‐up; (e)—Overall you were happy with the service provided; (f)—You would recommend the service to a friend.