Background The state of Queensland, Australia, is large (1.85 million km 2). The provision of bariatric care across the state is difficult as most major hospitals are concentrated in the capital city of Brisbane. We implemented a statewide telehealth service to improve access for rural patients in a public bariatric service. We report our early experiences with this service. Methods We reviewed all patients seen in the Bariatric Telehealth Clinic from 2017 to 2019. Patients underwent consultation through video-link software at their local hospital with the multidisciplinary team in Brisbane (surgeon, dietician and clinical nurse). Distances from Brisbane and number of visits were calculated. Telehealth patients were contacted by phone to complete a survey regarding their experiences. This was a 17-question Likert-style survey with scores from 1 (strongly disagree) to 5 (strongly agree). Results A total of 85 new patients underwent their initial consultation via telehealth. Each patient had a variable number of inperson as well as telehealth consultations both before and after surgery. Mean distance from telehealth consultation site to Brisbane was 614 km (range 149-2472 km). In total, 41 (48%) completed the survey. With regard to telehealth saving time and money, improving access to bariatric care, and desire to use telehealth again, the mean score was 4 out of 5 or higher for all questions (i.e., agree or strongly agree). There was no identifiable post-operative complication that was caused or exacerbated by telehealth. Conclusion Bariatric surgical telehealth appointments are feasible and preferred by most patients residing in rural and remote locations. Each consultation avoids significant travel time and cost for the patient and health service, with no obvious adverse outcomes. Telehealth improves equity and access to specialist services for rural and remote patients.

ABO compatible allogeneic blood transfusion (ABT) is associated with transfusion-related immune modulation (TRIM) and poor patient outcomes including perioperative infection and myocardial infarction. Intraoperative cell salvage (ICS) enables collection, processing and reinfusion of autologous blood lost during surgery. We investigated whether immune suppression associated with ABT could be reduced by using ICS. Suitable orthopaedic patients were consented and recruited to the study (n=20, HREC/17/QRBW/685). 10mL anticoagulated blood (EDTA) was collected from the patient (pre-operatively) and from the ICS blood product. An established whole blood culture model was used to assess changes to monocyte and myeloid dendritic cell (mDC) inflammatory responses (intracellular cytokine staining for IL-6, IL-8, IL-10, IL-12, IL-1α, TNF-α, MIP-1α, MIP-1β, MCP-1, IP-10) following exposure of the patient’s pre-operative blood to ABO compatible allogenic blood (Blood Service, Kelvin Grove) or their ICS blood (P<0.05 ANOVA). Exposure to ABT significantly suppressed the inflammatory response of both mDC (IL-10, IL-12, IL-1α, IL-8, TNF-a, MIP-α, MIP-1β) and monocytes (IL-10, IL-6, IL-12, IL-1α, IL-8, IL-10, IL-12, TNF-α and MIP-1α). Compared to ABT, exposure to the patients’ own (ICS) blood improved mDC IL-8, IL-10, IL-12, TNF-α and MIP-1α production and monocyte IL-10 and MIP-1β production. We provide in vitro evidence that ICS may reduce ABT associated adverse outcomes associated with improved inflammatory response and immune competence post-transfusion.