Telemedicine Visits can Generate Highly Accurate Diagnoses and Surgical Plans for Spine Patients

Patawut Bovonratwet, MD; Junho Song, BS; Yeo Eun Kim, BS; Daniel Shinn, BS; Kyle W. Morse, MD; James E. Dowdell, MD; Russel C. Huang, MD; Todd J. Albert, MD; Harvinder S. Sandhu, MD; Sheeraz A. Qureshi, MD, MBA; Sravisht Iyer, MD

Disclosures

Spine. 2022;47(17):1194-1202. 

In This Article

Abstract and Introduction

Abstract

Study Design: A Retrospective cohort study.

Objective: To (1) assess whether diagnoses and surgical plans established during a new patient telemedicine visit changed following an in-person evaluation and (2) determine any differences in perioperative outcomes between patients who only had a telemedicine visit before surgery versus those who had a telemedicine visit followed by an in-person evaluation before surgery.

Summary of Background Data: Data on capability of telemedicine to deliver high-quality preoperative assessment without a traditional in-person interaction and physical examination is lacking.

Materials and Methods: Records of patients who had a new patient telemedicine visit and indicated for surgery with documented specific diagnosis as well as surgical plans from a spine department at an urban tertiary center from April 2020 to April 2021 were reviewed. For a subset of patients that had a follow-up in-person evaluation before surgery, these diagnoses and plans were compared. Perioperative outcomes were compared between patients who only had a telemedicine visit before surgery versus those who had a telemedicine visit followed by an in-person evaluation before surgery.

Results: A total of 166 patients were included. Of these, 101 patients (61%) only had a new patient telemedicine visit before surgery while 65 (39%) had a telemedicine visit followed by an in-person evaluation. There were no differences in the rate of case cancellations before surgery and patient-reported outcome measures between these two groups (P>0.05). Of 65 patients who had both a telemedicine followed by an in-person visit, the diagnosis was unchanged for 61 patients (94%) and the surgical plan did not change for 52 patients (80%). The main reason for surgical plan change was due to updated findings on new imaging, 10 patients, (77%).

Conclusions: The current study suggests that telemedicine evaluations can provide an effective means of preoperative assessment for spine patients.

Level of Evidence: Level 3.

Introduction

The coronavirus disease 2019 (COVID-19) pandemic accelerated demand for technological innovation to allow for physical distancing, and in healthcare, telemedicine gained the spotlight. The major benefits of telemedicine include greater convenience for the patient and the provider, the removal of geographical limitations, lower costs, and ultimately greater efficiency.[1,2] During this period, most surgical specialties had to pivot to telemedicine visits and were often required to make surgical plans as well as diagnoses before an in-person evaluation.[3]

The field of spine surgery is typically viewed as traditionally relying on physical examination to dictate both the diagnosis and the surgical plan. However, telemedicine adoption among spine practices has been positive and demand is growing.[1,3] In a recent study, 95% of spine patients seen via telemedicine were "satisfied" or "very satisfied" with their telemedicine visit, with 62% stating it was "the same" or "better" than previous in-person appointments.[4] Due to these positive findings, recent studies have aimed to provide specific guidelines and a framework to allow for a more comprehensive spine patient evaluation, particularly focusing on the telemedicine physical examination.[5–9]

While these guidelines and framework have certainly helped surgeons substitute portions of a typical in-person physical examination, their ability to provide accurate diagnoses and ultimately surgical plans have not been validated. Data on whether or not a telemedicine visit alone is sufficient to indicate a patient for spine surgery is lacking and heavily debated.[3] Therefore, the purposes of this study were to (1) assess whether diagnoses and surgical plans established during a new patient telemedicine visit changed following an in-person evaluation and (2) determine any differences in perioperative outcomes between patients who only had a telemedicine visit before surgery versus those who had a telemedicine visit followed by an in-person evaluation before surgery.

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