Telemedicine in thoracic surgery

摘要

Background: We describe the safety, feasibility and patient satisfaction using telemedicine in the preoperative as well as postoperative period of thoracic surgery. Methods: A prospective safety, proof of concept and quality improvement project on a consecutive series of patients who had preoperative and/or part of their postoperative care via telemedicine. Results: Fifty-six patients (18% outside the United States) agreed to participate. A video conversation with patients and families was used to decide resectability, discuss risks, benefits, and alternatives of treatment and to agree on the date and type of surgery after medical records and imaging reviewed initially via email. All 56 underwent the planned operation, 55 on the date agreed upon. Eight (14%) patients met the surgeon for the first time on the morning of surgery: 38 (68%) had robotic pulmonary resection, 9 (16%) robotic esophagectomy and 9 (16%) robotic thymectomy. All had R0 resection. There was minor morbidity in 10 patients. There was no major morbidity or 30- or 90-day mortality. Postoperative visits via telemedicine only was performed in 25 of 56 patients (45%). Unscheduled postoperative telemedicine visits prevented six patients from unnecessary visits to local emergency departments. Patient satisfaction achieved the highest scores in the four areas of provider communication. Conclusions: Telemedicine is safe and avoids some preoperative and postoperative visits to surgeons’ offices. In selected patients it safely determines oncologic surgical resectability and patient fitness for major thoracic surgery, provide outstanding early safety and oncologic outcomes and high patient satisfaction. In addition, it reduces the need for some postoperative emergency department visits and in most patients it can eliminate postoperative travel to the surgeon’s office.