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Do postoperative telemedicine interventions with a communication feature reduce emergency department visits and readmissions?—a systematic review and meta-analysis

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Abstract

Introduction

Emergency department (ED) visits and readmissions after surgery are common and represent a significant cost-burden on the healthcare system. A notable portion of these unplanned visits are the result of expected complications or normal recovery after surgery, suggesting that improved coordination and communication in the outpatient setting could potentially prevent these. Telemedicine can improve patient–physician communication and as such may have a role in limiting unplanned emergency department visits and readmissions in postoperative patients.

Methods

Major electronic databases were searched for randomized controlled trials and cohort studies in surgical patients examining the effect of postoperative telemedicine interventions with a communication feature on 30-day readmissions and emergency department visits as compared to current standard postoperative follow-up. All surgical subspecialties were included. Two independent reviewers assessed eligibility, extracted data, and evaluated risk of bias using standardized tools. Our primary outcomes of interest were 30-day ED visits and readmissions. Our secondary outcomes were patient satisfaction with the intervention.

Results

29 studies were included in the final analysis. Fourteen studies were RCTs, and the remaining fifteen were cohort studies. Eighteen studies reported 30-day ED visit as an outcome. There was no overall reduction in 30-day ED visit in the telemedicine group (RR: 0.89, 95%CI: 0.70–1.12). Twenty-two studies reported 30-day readmission as an outcome. The overall pooled estimate did not show a difference in this outcome (RR: 0.90, 95%CI: 0.74–1.09). Fifteen studies reported a metric of patient satisfaction regarding utilization of the telemedicine intervention. All studies demonstrated high levels of satisfaction (> 80%) with the telemedicine intervention.

Discussion

This review fails to demonstrate a clear reduction ED visits and readmissions to support use of a telemedicine intervention across the board. This may be in part explained by significant heterogeneity in the proportions of potentially preventable visits in each surgical specialty. As such, targeting interventions to specific surgical settings may prove most useful.

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Funding

Bursary Award for Masters Training for Applicants with a Professional Degree–Fonds de la Recherche en Sante du Quebec (FRSQ)–2019–2021 Award# 273257.

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Authors and Affiliations

  1. Department of Surgery, McGill University Health Centre, Glen Campus–DS1.3310, 1001 Decarie Boulevard, Montreal, QC, H3G 1A4, Canada

    Jules Eustache & Lawrence Lee

  2. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada

    Jules Eustache, Charbel El-Kefraoui & Lawrence Lee

  3. Medical Libraries, McGill University Health Centre, Montreal, QC, Canada

    Taline Ekmekjian

  4. Department of Psychiatry, McGill University, Montreal, QC, Canada

    Eric Latimer

  5. Douglas Research Centre, Montreal, QC, Canada

    Eric Latimer

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  1. Jules Eustache
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  2. Charbel El-Kefraoui
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  4. Eric Latimer
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  5. Lawrence Lee
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Correspondence to Lawrence Lee.

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Disclosures

Dr Lee reported receiving research funding from Johnson & Johnson and is a consultant for Stryker, both of which are unrelated to the present manuscript. Dr. Latimer, Dr. Eustache, Mr. El-Kefraoui, Mrs. Ekmekjian have no conflicts or disclosures to report.

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Eustache, J., El-Kefraoui, C., Ekmekjian, T. et al. Do postoperative telemedicine interventions with a communication feature reduce emergency department visits and readmissions?—a systematic review and meta-analysis. Surg Endosc 35, 5889–5904 (2021). https://doi.org/10.1007/s00464-021-08607-7

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  • DOI: https://doi.org/10.1007/s00464-021-08607-7

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