Piloting total perioperative telemedicine for elective cholecystectomies for symptomatic cholelithiasis

Abstract

Background: Telemedicine has the potential to increase healthcare access while decreasing the environmental impact associated with providing care. We piloted total perioperative telemedicine (TPT) visits for evaluating patients with symptomatic cholelithiasis. We aimed to evaluate the feasibility and environmental impact of TPT by comparing the perioperative and environmental outcomes of patients participating in TPT to those undergoing traditional in-person preoperative evaluations.

Methods: During a six-month period in 2022, patients referred to a single provider at an academic tertiary care center for uncomplicated cholelithiasis were offered a preoperative telemedicine visit. Adverse events, number of perioperative clinical visits, and patient demographics were then collected retrospectively for elective cholecystectomies performed between 1/1/2022 and 12/31/2022. Perioperative outcomes were compared between patients who underwent TPT versus those evaluated in-person. Life cycle assessment was utilized to compare greenhouse gas (GHG) emissions (measured in kilograms of carbon dioxide equivalents, kgCO2-eq) between both groups.

Results: During the study period, 12 patients proceeded with elective cholecystectomy for symptomatic cholelithiasis after a preoperative telemedicine evaluation while 31 patients did so after an in-person evaluation. Patients participating in TPT had a similar adverse event rate (8.3% vs. 12.9%, p = 0.67, chi-squared test). Patients participating in TPT had more perioperative clinic visits on average compared to patients undergoing in-person preoperative evaluation (1.42 vs. 1.06, p = 0.004). Of the TPT group, 8 patients (67%) patients proceeded with surgery after initial telemedicine evaluation. TPT resulted in a 51% decrease in perioperative GHG emissions compared to patients who underwent in-person evaluation (60.2-60.9 kgCO2-eq vs. 123.4-123.5 kgCO2-eq, p = 0.0271).

Conclusion: This pilot study suggests that TPT is feasible for patients undergoing elective cholecystectomy for symptomatic gallstones. Additionally, TPT significantly reduces GHG emissions associated with caring for a patient through an elective procedure by reducing the average number of required trips to the medical facility.

Keywords: Cholecystectomy; Cholelithiasis; Environmental impact; Telehealth; Telemedicine.