Telehealth in surgery: an umbrella review

Abstract

Background Telehealth use has increased worldwide during the COVID‐19 pandemic. However, hands‐on requirements of surgical care may have resulted in slower implementation. This umbrella review (review of systematic reviews) evaluated the perceptions, safety and implementation of telehealth services in surgery, and telehealth usage in Australia between 2020 and 2021. Methods PubMed was searched from 2015 to 2021 for systematic reviews evaluating real‐time telehealth modalities in surgery. Outcomes of interest were patient and provider satisfaction, safety, and barriers and facilitators associated with its use. Study quality was appraised using the AMSTAR 2 tool. A working group of surgeons provided insights into the clinical relevance to telehealth in surgical practice of the evidence collated. Results From 2025 identified studies, 17 were included, which were of low to moderate risk of bias. Patient and provider satisfaction with telehealth was high. Time savings, decreased healthcare resource use and lower costs were reported as key advantages of the service. Inability to perform comprehensive examinations was noted as the primary barrier. In Australia, peak telehealth usage coincided with the introduction of temporary telehealth services and increased lockdown measures. Conclusions Patients and providers are broadly satisfied with telehealth and its benefits. Barriers may be overcome via multidisciplinary collaboration. Telehealth may benefit surgical care long‐term if implemented correctly both during and after the COVID‐19 pandemic.

A rapid review of the effectiveness of remote consultations versus face-to-face consultations in secondary care surgical outpatient settings

“…These have demonstrated the feasibility of the use of telemedicine for perioperative and/or postoperative care for adults and paediatric undergoing a variety of surgical procedures and overall, patients are satisfied with telemedicine in surgical practice. High patient and provider satisfaction for the use of telemedicine across a range of surgical specialities has previously been reported and is comparable to satisfaction obtained from in-person consultations (Smith et al 2021, Fahey et al 2021, McMaster et al 2021, Chaudhry et al 2021. There is a lack of evidence however, from existing systematic reviews of telemedicine for adult patients that have focused solely on the effectiveness of telemedicine during, and post COVID-19.…”

“…Based on preliminary searches conducted for a rapid evidence summary, we found an umbrella review (Smith et al 2021) and numerous systematic reviews investigating the use of telemedicine in surgical specialties as well as patient and/or provider satisfaction (Cabrera et al 2020, Fahey et al 2021, Gupta et al 2021, Kolcun et al 2020, Chaudhry et al 2021, McMaster et al 2021). However, in some of these systematic reviews the use of synchronous (video and telephone consultations) and asynchronous modalities (texting, e-mails, mobile applications, etc.)…”

“…Previous reviews (Petersen et al 2021, Gupta et al 2021, Kolcun et al 2020, Fahey et al 2021, McMaster et al 2021, Chaudhry et al 2021) and a review of systematic reviews (Smith et al 2021) have explored the usage, effectiveness or cost-effectiveness of telemedicine across a variety of surgical specialities prior to the COVID-19 pandemic. These have demonstrated the feasibility of the use of telemedicine for perioperative and/or postoperative care for adults and paediatric undergoing a variety of surgical procedures and overall, patients are satisfied with telemedicine in surgical practice.…”

“…However, in some of these systematic reviews the use of synchronous (video and telephone consultations) and asynchronous modalities (texting, e-mails, mobile applications, etc.) were often considered together, and separating their impact on outcomes was not possible (Smith et al 2021). The umbrella review found that the most commonly reported outcome was patient satisfaction although this measure is not necessarily indicative of whether remote consultations and telemedicine was effective in improving clinical and patient reported outcomes (Smith et al 2021).…”

“…were often considered together, and separating their impact on outcomes was not possible (Smith et al 2021). The umbrella review found that the most commonly reported outcome was patient satisfaction although this measure is not necessarily indicative of whether remote consultations and telemedicine was effective in improving clinical and patient reported outcomes (Smith et al 2021). In addition, systematic reviews often included mixed populations of both adults and children, even though remote consultations for children can require a different approach, such as parents with young children having to describe symptoms in absence of physical examination (Tully et al 2021).…”