Chijioke Chukwudi MD , Ruby Singh MD, MPH , Thais Faggion Vinholo MD, MS , Ben Grobman BS , Patrick Udeh BS , Ashraf Sabe MD , Borami Shin MD , David A. D'Alessandro MD , Thoralf M. Sundt III MD , Asishana A. Osho MD, MPH
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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.</div></div><div><h3>Results</h3><div>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 <em>P</em> values < .05); they underwent more isolated mitral (27% vs 20%; <em>P</em> = .006), and fewer isolated aortic procedures (3% vs 5%; <em>P</em> = .005). Adjusted 1-year mortality was similar between both groups (adjusted hazard ratio, .8; 95% CI, 04-1.4; <em>P</em> = .371). There was no difference in secondary outcomes between the 2 groups (all <em>P</em> values > .05). We found no difference in the proportion of patients with high Social Vulnerability Index between groups (12% vs 14%; <em>P</em> = .28). More telehealth patients resided further than 67 miles from the hospital (23% vs 17%; <em>P</em> = .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.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that telehealth may be efficiently and safely used for preoperative evaluation of patients undergoing elective cardiac surgery.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 138-146"},"PeriodicalIF":1.9000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Surgical outcomes following telehealth preoperative evaluation in elective cardiac surgery\",\"authors\":\"Chijioke Chukwudi MD , Ruby Singh MD, MPH , Thais Faggion Vinholo MD, MS , Ben Grobman BS , Patrick Udeh BS , Ashraf Sabe MD , Borami Shin MD , David A. D'Alessandro MD , Thoralf M. Sundt III MD , Asishana A. Osho MD, MPH\",\"doi\":\"10.1016/j.xjon.2025.06.010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 <em>P</em> values < .05); they underwent more isolated mitral (27% vs 20%; <em>P</em> = .006), and fewer isolated aortic procedures (3% vs 5%; <em>P</em> = .005). Adjusted 1-year mortality was similar between both groups (adjusted hazard ratio, .8; 95% CI, 04-1.4; <em>P</em> = .371). There was no difference in secondary outcomes between the 2 groups (all <em>P</em> values > .05). We found no difference in the proportion of patients with high Social Vulnerability Index between groups (12% vs 14%; <em>P</em> = .28). More telehealth patients resided further than 67 miles from the hospital (23% vs 17%; <em>P</em> = .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.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that telehealth may be efficiently and safely used for preoperative evaluation of patients undergoing elective cardiac surgery.</div></div>\",\"PeriodicalId\":74032,\"journal\":{\"name\":\"JTCVS open\",\"volume\":\"26 \",\"pages\":\"Pages 138-146\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JTCVS open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666273625002165\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JTCVS open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666273625002165","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的：远程医疗术前评估已被证明可以改善获得护理的机会，减少预约取消，并支持跨多个外科专科的有效程序规划。然而，很少有研究评估择期心脏手术患者的安全性和有效性。方法：我们进行了一项回顾性多机构队列研究，比较了2020年3月1日至2021年3月1日期间接受远程医疗和现场术前评估的择期心脏手术患者的手术和术后结果。主要终点是使用Kaplan-Meier曲线和多变量Cox回归评估1年死亡率。使用多变量线性或逻辑回归评估手术时间、再手术、再入院、深静脉血栓形成、术后再出血、败血症、延长通气时间、重症监护病房住院时间和住院时间等次要结局。结果共纳入559例远程医疗评估患者和554例现场评估患者。远程医疗组的女性、吸烟者、依赖透析的患者和接受医疗保险/医疗补助的患者较少（P值均为0.05）；他们接受了更多的分离二尖瓣手术（27%比20%；P = 0.006），较少的分离主动脉手术（3%比5%；P = 0.005）。两组间调整后的1年死亡率相似（调整后的风险比为0.8;95% CI, 04-1.4; P = 0.371）。两组间次要结局无差异（P值均为>； 0.05）。我们发现两组间社会脆弱性指数高的患者比例无差异（12% vs 14%; P = 0.28）。更多的远程医疗患者居住在距离医院67英里以上的地方（23%对17%；P = .03），节省的中位数为2.4加仑汽油（范围，1.0-4.6加仑汽油）和91.8分钟（范围，39.6-182分钟）的旅行时间。结论远程医疗可有效、安全地用于择期心脏手术患者的术前评估。
Surgical outcomes following telehealth preoperative evaluation in elective cardiac surgery
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.
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