Surgical outcomes following telehealth preoperative evaluation in elective cardiac surgery

Abstract

Objective

Telehealth preoperative evaluations have been shown to improve access to care, reduce appointment cancellations, and support efficient procedural planning across multiple surgical subspecialties. However, few studies have assessed the safety and efficacy in patients undergoing elective cardiac surgery.

Methods

We conducted a retrospective multi-institutional cohort study comparing procedural and postoperative outcomes for patients who had telehealth versus in-person preoperative evaluations for elective cardiac surgery between March 1, 2020, and March 1, 2021. Primary outcome was 1-year mortality assessed using Kaplan-Meier curves and multivariable Cox regression. Secondary outcomes of procedural duration, reoperations, readmission, deep vein thrombosis, postoperative rebleeding, sepsis, prolonged ventilation, intensive care unit length of stay, and hospital length of stay were assessed using multivariable linear or logistic regression.

Results

Five hundred fifty-nine patients who were evaluated through telehealth and 554 patients who were evaluated in person were included. The telehealth group had fewer women, smokers, dialysis-dependent patients, and patients on Medicare/Medicaid (all P values < .05); they underwent more isolated mitral (27% vs 20%; P = .006), and fewer isolated aortic procedures (3% vs 5%; P = .005). Adjusted 1-year mortality was similar between both groups (adjusted hazard ratio, .8; 95% CI, 04-1.4; P = .371). There was no difference in secondary outcomes between the 2 groups (all P values > .05). We found no difference in the proportion of patients with high Social Vulnerability Index between groups (12% vs 14%; P = .28). More telehealth patients resided further than 67 miles from the hospital (23% vs 17%; P = .03) and had median savings of 2.4 gas-gallons (range, 1.0-4.6 gas-gallons and 91.8 minutes (range, 39.6-182 minutes) of travel time.

Conclusions

Our findings suggest that telehealth may be efficiently and safely used for preoperative evaluation of patients undergoing elective cardiac surgery.