Complete Telehealth for Multidisciplinary Preoperative Workup Does Not Delay Time to Metabolic and Bariatric Surgery: a Pilot Study

Abstract

Purpose The COVID-19 pandemic accelerated implementation of telehealth throughout the US healthcare system. At our institution, we converted a fully integrated multidisciplinary bariatric clinic from face-to-face visits to entirely telehealth video/telephone visits. We hypothesized telehealth would increase the number of provider/patient encounters and therefore delay time to surgery. Methods This is a retrospective review of consecutive patients who underwent total telehealth preoperative workup. Demographics, comorbidities, and surgical characteristics were compared to the same number of consecutive patients who underwent a face-to-face approach 12 months prior, using a Wilcoxon test for continuous variables and chi-square or Fisher’s exact test for categorical variables. Differences between time and surgery were compared using inverse probability of treatment-weighted estimates and number of preoperative visits using Poisson regression with distance to hospital as a confounder. Noninferiority margin for time to surgery was set to 60 days, and the number of visits was set to 2 visits. Results Between March of 2020 and December of 2021, 36 patients had total telehealth workup, and were compared to 36 patients in the traditional group. Age, sex, body mass index, and comorbidities did not differ between groups. The average number of days to surgery was 121.1 days shorter in the telehealth group (90% bootstrap CI [− 160.4, − 81.8]). Estimated shift in the total number of visits was additional .76 visits in the traditional group (90% CI [.64, .91). Conclusions The total telehealth approach to preoperative bariatric multidisciplinary workup did not delay surgery and decreased number of total outpatient visits and time to surgery. Graphical abstract

Follow-Up, Safety, and Satisfaction with Tele-bariatric Follow-Up Implemented During the COVID-19 French Lockdown: a 2-Year Follow-Up Study

“…Three patients (3.7%) in our study population switched to TC during the preoperative bariatric assessment and were operated when surgical rooms were reopened for nonemergency care, and all 3 are still in active follow-up. Mills et al recently reported completely virtualized multidisciplinary preoperative management during the pandemic without negative impact on preoperative workup in comparison with conventional management [34]. Several observational studies [17] have shown that TM integrated into preoperative bariatric programs improved overall patient satisfaction, connection with the multidisciplinary team, and perceptions regarding their knowledge of nutrition a healthier lifestyle.…”

Effect of telehealth‐based versus in‐person nutritional and exercise intervention on type II diabetes mellitus improvement and efficiency of human resources utilization in patients with obesity

“…This was in agreement with a recent study by Mills et al which reported a significant reduction in time and the number of visits from the initial appointment to bariatric surgery when patients received telehealth‐based versus in‐person care. Mills et al, however, did not assess no‐show rates or achieved any weight loss 7 . Every effort was made that both groups in the present study were scheduled to have the same appointment frequency to reduce any effect on program duration.…”

“…Mills et al, however, did not assess no-show rates or achieved any weight loss. 7 Every effort was made that both groups in the present study were scheduled to have the same appointment frequency to reduce any effect on program duration.…”

“…Telehealth implementation in an adolescent bariatric surgery program led to an increase in attendance rates (83.1% vs. 70.5%) and a reduction in cancellation rates (9.9% vs. 22.5%) compared to in‐person appointments 6 . Furthermore, conversion to a total telehealth approach for the preoperative bariatric multidisciplinary workup decreased the time to surgery and the number of total outpatient visits and time to surgery but no weight loss was achieved 7 . In addition, a statistically non‐significant reduction in bariatric group‐visit no‐show rates (16.45% vs. 11.54%) has been reported after telehealth implementation in a bariatric surgery program, but correlation with weight loss outcomes or comorbidity improvement was not examined 8 .…”

“… 6 Furthermore, conversion to a total telehealth approach for the preoperative bariatric multidisciplinary workup decreased the time to surgery and the number of total outpatient visits and time to surgery but no weight loss was achieved. 7 In addition, a statistically non‐significant reduction in bariatric group‐visit no‐show rates (16.45% vs. 11.54%) has been reported after telehealth implementation in a bariatric surgery program, but correlation with weight loss outcomes or comorbidity improvement was not examined. 8 The effect of telehealth on resource utilization specifically for the management of adults with obesity and diabetes and in conjunction with clinical outcomes has not been previously investigated.…”