A recent study conducted by the University of Pittsburgh Medical Center has shown that total preoperative telemedicine in bariatric surgery is associated with noninferior clinical outcomes and hospital utilization compared with traditional, in-person patient care. The study highlights the advantages of telemedicine in terms of cost and time savings, which may facilitate access to bariatric surgery for the underserved.
Bariatric surgery is the most effective treatment for medically refractory weight loss in people with severe obesity. However, low-income patients and patients from minoritized racial and ethnic groups have difficulty accessing health care, which makes them less likely to consider bariatric surgery as a treatment option. Despite the widely encompassing referral criteria for adults laid forth by the National Institutes of Health, less than 1% of eligible patients with obesity undergo bariatric surgery, despite the fact that it is safe, effective, and economical.
To investigate the role of telemedicine in bariatric surgery, the University of Pittsburgh Medical Center conducted a single-institution, retrospective, noninferiority cohort study in accordance with Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. The study used patient data collected from a contemporary cohort of patients who underwent laparoscopic Roux-en-Y gastric bypass (RNY) or sleeve gastrectomy (SG) after total telemedicine preoperative surgical evaluation, and compared it with a historical control cohort of patients who underwent RNY or SG after traditional in-person surgical evaluation.
The study collected patient demographic, socioeconomic, and medical variables through medical record review. Demographic variables included age, sex, race, ethnicity, and primary language. Socioeconomic variables included marital status, employment status, and insurance coverage. Medical variables collected were preoperative body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), recent postoperative BMI, and presence of selected comorbidities, including anxiety or depression, type 2 diabetes, gastroesophageal reflux disease, and hypertension.
The study found that postoperative clinical outcomes and hospital utilization for patients undergoing bariatric surgery after exclusively telemedicine-based preoperative evaluation are noninferior to patients receiving traditional, in-person care. The study demonstrated no differences in race or ethnicity between telemedicine and traditional preoperative care groups. Moreover, the study found that hospital utilization measured by postoperative emergency department (ED) visits and hospital readmission within 30 days were noninferior in the telemedicine group compared with the control group. After performing adjusted analyses using stepwise logistic regression, the study found that telemedicine was not associated with a higher risk of 30-day ED visit, 30-day hospital readmission, or major adverse events.
However, the study had several limitations. It was a single institution and single surgeon study, which may limit external generalizability. The retrospective nature of the study may also introduce unintended bias. Additionally, all individuals in the telemedicine group had preoperative evaluation and bariatric surgery during the COVID-19 pandemic, which may have resulted in inherently discrepant cohort characteristics and possibly patient care. The postoperative follow-up period was limited to 60 days, which may have limited annotation of more long-term complications.
The researchers concluded that telemedicine may expand the reach of bariatric surgery and narrow disparities for historically disinvested patient populations. They noted that further investigations should focus on geographical differences between telemedicine and traditional, in-person patient populations and ensure both patient and clinician satisfaction.