Abstract
While the safety of video follow-up in bariatric surgery is established, patients’ perception of telemedicine visits remained unknown. A randomized clinical trial evaluating patients’ perception of video postoperative follow-up (F/U) visits was conducted in the pre COVID-19 era. 24 patients were randomized in the preoperative clinic to receive either in-person or video F/U, and then surveyed about their experience and preference. The majority reported that if they had to do it over, they would prefer a video visit. Among those who received video visits, 11/12 reported that the lack of physical contact was acceptable. 82% of the video group expressed that their visit was better or as good as an in-person visit, while 9% were not sure, and 9% reported that video was worse. This finding suggests that postoperative video follow-up visits are acceptable among bariatric surgery patients and should be offered as an alternative to traditional visits.
Keywords: bariatric, telemedicine
Even before the COVID-19 pandemic’s influence on virtual health care, telemedicine visits were increasingly considered in surgical care as recent studies showed their safety and efficiency. 1 However, patients’ impression of telemedicine over traditional perioperative visits has not been studied. We conducted a randomized trial evaluating bariatric surgery patients’ perception of video postoperative visits in the pre COVID-19 era.
Adults undergoing first time Roux-en Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at one institution met inclusion criteria if English-speaking, living further than 70 miles away from our hospital, with access to electronic devices, and were in the United States at the time of their first postoperative follow-up. After obtaining institutional review board approval and informed consents, stratified randomization based on procedure (RYGB/SG) and sex was performed in the preoperative clinic visits in a 1:1 ratio. Patients were randomized to receive either in-person or video postoperative follow-up.
Within 5 to 19 days after undergoing the postoperative follow-up, participants were surveyed via telephone by our Research Survey Center about their preference of the follow-up visit (survey is available via the on-line version of the paper). Participants were contacted up to 5 times: two during the day, two during the evening and 1 on weekends.
Data were analyzed using Chi-square and Wilcoxon Rank Sum tests. Analysis was performed using SAS version 9.4 statistical software (SAS Institute, Inc. Cary, NC).
Between May 2019 and February 2020, 49 patients met inclusion criteria, and 24 were enrolled; those who refused randomization (n=25) were split between requesting video (12) or in-person visits (13).
The 24 participants were randomized to either in-person (n=11) or video (n=13) visits; 20 (83%) completed the survey and four withdrew (1 was lost to follow-up and 3 changed their randomized group). Table 1 summarizes baseline characteristics of participants.
Table 1.
Comparison of Baseline Characteristics Between Groups.
| In-Person Visit (N = 11) | Video Visit (N = 13) | Total (N = 24) | P-Value | |
|---|---|---|---|---|
| Gender | .42 a | |||
| Male | 3 (27.3%) | 6 (46.2%) | 9 (37.5%) | |
| Female | 8 (72.7%) | 7 (53.8%) | 15 (62.5%) | |
| Age at surgery | .88 b | |||
| Mean (SD) | 50.3 (10.5) | 48.7 (11.9) | 49.4 (11.1) | |
| Median | 49.5 | 48.5 | 49.0 | |
| Q1, Q3 | 39.8, 61.2 | 43.0, 58.9 | 40.9, 59.3 | |
| Range | (36.9-64.9) | (24.4-65.6) | (24.4-65.6) | |
| Procedure | 1.0 a | |||
| Gastric sleeve | 4 (36.4%) | 5 (38.5%) | 9 (37.5%) | |
| Roux-en-Y | 7 (63.6%) | 8 (61.5%) | 15 (62.5%) | |
| Distance, mi (residence to hospital) | .14 b | |||
| Mean (SD) | 285.8 (407.7) | 234.8 (226.9) | 258.2 (315.9) | |
| Median | 96.0 | 138.0 | 118.5 | |
| Q1, Q3 | 81.0, 223.0 | 112.0, 285.0 | 89.5, 254.0 | |
| Range | (73.0-1107.0) | (84.0-920.0) | (73.0-1107.0) | |
| Estimated time to travel to hospital one way? | .23 b | |||
| N | 9 | 11 | 20 | |
| Mean (SD) | 2.2 (1.2) | 2.7 (.6) | 2.5 (.9) | |
| Median | 2.0 | 3.0 | 2.5 | |
| Q1, Q3 | 1.0, 3.0 | 2.0, 3.0 | 2.0, 3.0 | |
| Range | (1.0-4.0) | (2.0-4.0) | (1.0-4.0) | |
| Duration between surgery and follow-up, days | <.01 b | |||
| Mean (SD) | 22.2 (2.6) | 33.0 (7.4) | 28.0 (7.9) | |
| Median | 22.0 | 34.0 | 25.0 | |
| Q1, Q3 | 20.0, 24.0 | 25.0, 39.0 | 22.5, 34.5 | |
| Range | (17.0-27.0) | (24.0-46.0) | (17.0-46.0) | |
| Duration between follow-up and survey, days | .70 b | |||
| N | 9 | 11 | 20 | |
| Mean (SD) | 11.8 (4.1) | 10.6 (4.1) | 11.2 (4.0) | |
| Median | 11.0 | 12.0 | 11.5 | |
| Q1, Q3 | 10.0, 13.0 | 7.0, 14.0 | 7.5, 14.0 | |
| Range | (6.0-19.0) | (5.0-16.0) | (5.0-19.0) |
aFisher’s exact test.
bWilcoxon rank sum test.
The majority (65% of our entire cohort and 73% of the video group) reported that if they had to do it over, they would prefer a video visit (Table 2). One person in the video group experienced technical difficulties and would prefer an in-person visit. Among those who received video visits, 11/12 reported that the lack of physical contact was acceptable, and 4/12 reported encountering technical difficulties. However, 82% of the video group expressed that their visit was better or as good as an in-person visit, while 9% were not sure and 9% reported that video was worse.
Table 2.
Patient Perception of Telemedicine and Answers to Survey.
| In-Person Visit (N=11) | Video Visit (N=13) | Total (N=24) | P-Value | |
|---|---|---|---|---|
| How likely or unlikely would you be to accept an invitation to meet with your bariatric provider via video call from your home when you do not need new labs/imaging, your physician can review outside labs/imaging, and no physical exam/procedure is needed? | .54 a | |||
| Missing | 2 | 2 | 4 | |
| Neutral | 0 (.0%) | 1 (9.1%) | 1 (5.0%) | |
| Somewhat likely | 2 (22.2%) | 0 (.0%) | 2 (10.0%) | |
| Very likely | 7 (77.8%) | 10 (90.9%) | 17 (85.0%) | |
| I am confident that I would be able to connect to a video call based on my level of computer expertise | .21 a | |||
| Missing | 2 | 2 | 4 | |
| Disagree | 0 (.0%) | 1 (9.1%) | 1 (5.0%) | |
| Agree | 0 (.0%) | 1 (9.1%) | 1 (5.0%) | |
| Strongly agree | 9 (100.0%) | 9 (81.8%) | 18 (90.0%) | |
| If you had to do it over, which follow-up would you choose? | .70 b | |||
| Missing | 2 | 2 | 4 | |
| Video call | 5 (55.6%) | 8 (72.7%) | 13 (65.0%) | |
| In-person | 1 (11.1%) | 1 (9.1%) | 2 (10.0%) | |
| Uncertain | 3 (33.3%) | 2 (18.2%) | 5 (25.0%) | |
| I believe I can get the same quality of care from a video call as from an in-person visit | .97 a | |||
| Missing | 2 | 2 | 4 | |
| Strongly disagree | 1 (11.1%) | 0 (.0%) | 1 (5.0%) | |
| Disagree | 0 (.0%) | 1 (9.1%) | 1 (5.0%) | |
| Neither agree nor disagree | 1 (11.1%) | 1 (9.1%) | 2 (10.0%) | |
| Agree | 2 (22.2%) | 3 (27.3%) | 5 (25.0%) | |
| Strongly agree | 5 (55.6%) | 6 (54.5%) | 11 (55.0%) | |
| I would prefer to see a video over seeing a provider rather than bear the costs of travel | .54 a | |||
| Missing | 2 | 2 | 4 | |
| Strongly disagree | 0 (.0%) | 1 (9.1%) | 1 (5.0%) | |
| Disagree | 1 (11.1%) | 1 (9.1%) | 2 (10.0%) | |
| Neither agree nor disagree | 0 (.0%) | 1 (9.1%) | 1 (5.0%) | |
| Agree | 3 (33.3%) | 3 (27.3%) | 6 (30.0%) | |
| Strongly agree | 5 (55.6%) | 5 (45.5%) | 10 (50.0%) |
aWilcoxon rank sum test.
bChi-square test.
While the safety of video follow-up has been established, 1 patients’ perception of telemedicine visits remained unknown. This randomized clinical trial showed that patients’ acceptance and preference of telemedicine postoperative visits were noninferior to in-person visits, and in fact the majority of patients reported the same quality of care from a video as expected from an in-person assessment. While the transition to telemedicine care is rapidly evolving in the COVID-19 era, which may have led to increased familiarity and preference of telemedicine visits, it is important to note that our assessment of patients satisfaction was conducted before, and ended by, the pandemic.2,3
Our results along with other studies highlight that telemedicine visits can be alternative to traditional visits among surgical patients.2,3 We elected to assess its role in bariatric surgery patients as they necessitate long term follow-up yet loss to follow-up is common and associated with worse outcomes. 4 Given promising results regarding patient satisfaction, our plan is to expand the use of telemedicine in our bariatric practice overall and to long term follow-up.
Routine postoperative video follow-up visits are acceptable among bariatric surgery patients and can be alternative to traditional visits. Further studies are needed to evaluate the role of telemedicine visits in long term follow-up among these patients.
Supplemental Material
Supplemental Material, sj-pdf-1-asu-10.1177_00031348211054547 for Telemedicine Video Follow-Up for Bariatric Surgery Patients: What Do Patients Prefer? A Prepandemic Pilot Randomized Clinical Trial by Alaa Sada, William S. Harmsen, Travis J. McKenzie, Todd A. Kellogg, Omar Ghanem, Michael L. Kendrick and Elizabeth B. Habermann in The American Surgeon
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funded by the Department of Surgery at Mayo Clinic, Rochester, MN and the Noaber Foundation.
Supplementary Material: Supplementary material for this article is available online.
References
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Supplementary Materials
Supplemental Material, sj-pdf-1-asu-10.1177_00031348211054547 for Telemedicine Video Follow-Up for Bariatric Surgery Patients: What Do Patients Prefer? A Prepandemic Pilot Randomized Clinical Trial by Alaa Sada, William S. Harmsen, Travis J. McKenzie, Todd A. Kellogg, Omar Ghanem, Michael L. Kendrick and Elizabeth B. Habermann in The American Surgeon