Telemedicine in the Perioperative Period: Four Key Applications Transforming Surgical Care Accessibility and Affordability
A recent study published in the British Journal of Surgery (BJS) indicates that direct medical expenses for surgery may push nearly 44% of the global population into financial hardship, underscoring the heightened pressure to reduce surgical costs. Meanwhile, The Lancet Commission on Global Surgery has called for the elimination of poverty caused by surgical expenses by 2030.
To make surgery accessible and affordable for the global population, we need to harness the power of technology to streamline processes, expand access, and reduce costs. Telemedicine is likely central to achieving this goal. While telemedicine has generally been well accepted by patients with chronic conditions, it now appears to be favored by surgical patients as well. One study indicated that over 90% of cholecystectomy patients and 70% of hernia repair patients used telemedicine as their sole method for postoperative follow-up. Recent findings suggest that, in fact, most patients prefer telemedicine follow-up after undergoing less complex surgical procedures.
Although the role of telemedicine in the perioperative process is still being explored, the following four applications have fulfilled the promise of improving efficiency, accessibility, and value during this period. This has been compiled and reported by VCBeat (WeChat Official Account: vcbeat).
Many rural healthcare centers are already leveraging telemedicine technologies for remote preoperative assessments, particularly in remote areas where geographical distance limits the possibility of face-to-face consultations between physicians and patients.
According to a study titled “Telemedicine in Pediatric Surgery: Patient and Physician Satisfaction” by Salma Shivji et al., published in the Journal of Pediatric Surgery, 97% of patients and 73% of physicians at a rural pediatric center reported satisfaction with the use of telemedicine for preoperative consultations. The study also found that such virtual visits significantly reduced surgical costs, with nearly half of the patients reporting savings of more than $500 in travel expenses.
The study was conducted at the Stollery Children’s Hospital, which serves patients across a catchment area of at least 650,000 square kilometers, with approximately 50% of patients residing outside the Edmonton metropolitan area. By collecting survey data from patients and clinicians, combined with observations of recent telemedicine experiences, the study concludes that telemedicine represents a transformation in healthcare delivery. For a large number of clinicians and patients living in highly remote areas, it is an acceptable, effective, and appropriate modality for consultations and follow-up care.
Three Approaches to Remote Preoperative Assessment
Leveraging Mobile Applications—In a study, M. Howell et al. aimed to develop an iPad application that allows patients to complete electronic questionnaires, thereby reducing the time spent on consultation and delivery processes and significantly improving the efficiency of preoperative assessments. Meanwhile, electronic pre-assessment can reduce the demand for healthcare facilities, improve patient care, and facilitate patient triage prior to visits.
Leveraging computer-based health assessment software, the project by Bernhard Holzner and colleagues aims to develop a Computerized Health Assessment System (CHES) focused on monitoring individual patients’ electronic patient-reported outcomes. Patients can enter data via tablets and complete questionnaires under the guidance of online nurses. Compared with traditional methods, this software saves human resources and economic costs, while assessment results are immediately available to healthcare providers.
Applications of Media Space—Stevenson et al. integrated the use of media space in telemedicine assessments. Relying on data sharing as well as video and audio links, media space provides interactive channels for individuals across different regions. It will facilitate extensive interpersonal communication and data sharing between physicians and patients.
A recent study in Virginia emphasizes that postoperative visits for patients in remote areas should prioritize patient convenience to the greatest extent. However, from the perspective of postoperative patients, few things are less appealing than undertaking a long journey back to the hospital only to wait an hour for a 10-minute examination. Nevertheless, for patients in nursing homes and rehabilitation facilities, using telemedicine technologies for postoperative assessments remains particularly advantageous: returning to the hospital not only imposes financial and logistical burdens but also encroaches on valuable time dedicated to physical therapy.
To better facilitate remote postoperative care, SeamlessMD, a company based in Toronto, Canada, has developed a tool for pre- and post-operative patient engagement, securing $1.1 million in funding from BDC Capital, Funders Club, and angel investors. “Surgery has become one of the most challenging experiences for patients and their families,” said Joshua Liu, CEO of SeamlessMD, in a statement. “SeamlessMD extends healthcare into the community, enabling patients to manage their conditions at home. We take great pride in knowing that our platform helps patients avoid life-threatening blood clots after surgery, receive timely treatment for infections, and prevent unnecessary emergency room visits.”
In rural and remote areas, the scarcity of surgical specialists often leads to an inability to manage complex surgical cases. Typically, audio and visual information are sufficient for specialists to make precise diagnoses and formulate treatment plans for patients, whether in emergency departments or clinics.
Telemedicine is particularly well-suited for plastic surgery, as diagnosis in this specialty relies primarily on visual information and imaging data. A 2016 study found that when emergency physicians transmitted key clinical information and images to remote plastic surgeons, response times decreased from 48 minutes to 8 minutes. Furthermore, there was over 85% concordance between in-person consultations and virtual visual consultations.
According to Mobi Health News, the number of telemedicine video consultations and visits will reach 158.4 million annually by 2020. This figure includes both physician-to-physician consultations and video visits between patients and doctors. Research firms predict that although face-to-face clinical consultations currently account for more than 75% of the market, non-clinical consultations will grow rapidly in the coming years, eventually surpassing clinical consultations in volume. Charul Vyas, Chief Analyst at Tractica, stated in a press release, “The flexibility and high efficiency of video consultations deliver tangible benefits to both physicians and patients, and video-based patient monitoring programs will significantly promote positive therapeutic outcomes and cost savings.”
Performing surgery on the same patient across different time zones? This is not a scene from science fiction. As early as September 7, 2001, surgeon Jacques Marescaux successfully performed a cholecystectomy on a patient in France, 6,230 kilometers away from New York, using a robotic surgical system. This landmark procedure was named “Operation Lindbergh,” in recognition of Charles Lindbergh’s pioneering transatlantic flight route from New York to Paris. Since then, Canadian surgeon Mehran Anvari has performed surgeries on more than 20 patients residing in Northern Ontario, located 400 kilometers away from Dr. Anvari’s base in Hamilton, Canada.
These successes have naturally sparked strong interest in the further development of remote surgery. The U.S. military is striving to apply remote surgery to its “Trauma Pod” project, hoping that one day it can help military units significantly increase the survival chances of injured soldiers. Dr. Anderson recently led a project aimed at improving and advancing remote surgery technologies to enhance the accessibility of oncologic surgeries worldwide. Although ethical and regulatory issues currently limit the widespread implementation of remote surgery, as Dr. Anvari stated, the science is already here; can widespread adoption of remote surgery be far behind?