Predictors of Attitudes Toward Telemedicine and Its Usage Among Surgeons: A Multi-Center Cross-Sectional Study

Abstract

Background:

Telemedicine facilitates remote consultations and expands access to healthcare, marking a transformative shift in the medical field. Given the critical role of surgeons in the healthcare system, the adoption of telemedicine in surgical practice offers both distinct benefits and challenges. This research aims to assess the predictors of telemedicine attitudes and usage among surgeons in Jeddah, Saudi Arabia.

Methods:

An analytical cross-sectional study was carried out among 198 surgeons from public and private hospitals in Jeddah using convenience sampling technique. Data were collected in person using a pre-designed and validated questionnaire. Data analysis was carried out by IBM SPSS version 26. Chi-square tests and binary logistic regression were used to identify significant factors influencing surgeons’ attitudes and usage of telemedicine.

Results:

Among the participants, 54.5% reported having used telemedicine at least once in the past. Bivariate analysis revealed that surgeons in private hospitals (64.9%) were more likely to use telemedicine than those in public hospitals (40.4%; P = .001). Females were also associated with a higher usage (67.5%) in comparison to males (45.7%; P = .003). Frequent users were found to have less positive attitude compared to occasional users (35.4% vs 60.7%) (P < .001). Key concerns shaping attitudes toward telemedicine included limited ability to perform physical examinations, with 32.8% strongly agreeing, and concerns about the reliability of teleconsultation technology, reported by 40.9% of participants. Binary logistic regression revealed that prior usage or exposure to telemedicine was the only significant predictor of positive attitudes, with an odds ratio of 5.688 (95% confidence interval: 1.593-20.313; P = .007).

Conclusion:

The inclusion of telemedicine in surgical practice in Jeddah, especially within private healthcare settings, appears promising. The most consistent and significant predictor of positive attitudes toward telemedicine was prior use, as surgeons with previous exposure were more likely to hold favorable views.

Introduction

Traditionally, preoperative surgical planning and postoperative follow-up include in-person visits to the hospital or clinic, which often require patients to travel to the healthcare facility, for consultations, MRIs, X-rays, or CT scans, ECGs, blood tests before undergoing surgery, and appointments for follow-up to monitor the recovery and address any complications.^{1 -3} Some aspects of in-person visits may be less effective when patients face logistical challenges, such as geographical barriers, travel costs, scheduling conflicts, and lengthy wait times due to the high patient load which can lead to dissatisfaction and frustration, ultimately affecting the quality of care received.^4,5 Hence, surgeons appreciate the ability to use high-quality video calls for visually examining wounds, incision sites, and overall patient progress. However, some express concerns about the limitations of virtual exams, particularly when physical examinations are essential for accurate diagnosis or treatment planning. ⁶

In recent years, technological advancements have led to the development of alternative methods for patient engagement, including remote monitoring through interventions such as telemedicine. It has emerged as an advanced, powerful mode of providing medical services and has become a widespread practice among physicians worldwide, especially surgeons. These digital services encompass mobile technology for preoperative planning and postoperative follow-ups, thereby minimizing the number of visits, saving time, costs, and travel while providing high-quality clinical services virtually. ⁶

According to a cross-sectional study conducted among 462 members from American College of Surgeons, Resident and Associate Society to identify knowledge and perception of telehealth, in their respective institutions, 62.8% of surgeons were considered to be knowledgeable about telehealth technologies. Among these surgeons, the majority (94.4%), reported a decreased clinic volume for in-person visits, while 95.7% observed an increase in virtual clinic volume. ⁷ Another nationwide cross-sectional study in Australia surveyed 907 surgeons regarding the use of telehealth in post-operative care and found that 26% of them had used it in the past 3 months. Some of the main barriers were concerns about not being able to perform physical exams and a belief that telemedicine doesn’t match the quality of in-person consultations. Logistical challenges, such as difficulty in scheduling teleconsultations, were also noted. However, among recent telehealth users, these issues didn’t appear to be of much significance. Factors associated with higher telehealth use included younger age, familiarity with medical care reimbursement, and specialties like neurosurgery, urology, pediatric, and plastic surgery. ⁸

Moreover, a study conducted among physicians in Saudi Arabia viewed telemedicine as a time-saving and efficient alternative, though concerns about the quality of care and the need for training remain. Among 151 physicians, 57.6% agreed that telemedicine saved travel time, helped them complete tasks more quickly, although 28.5% of physicians expressed dissatisfaction with telemedicine services. ⁹ Additionally, according to another descriptive cross-sectional study carried out in Riyadh, Saudi Arabia, among 391 physicians, 90% believed that telemedicine can save time and money and 77% agreed that continuous training was required to use telemedicine. ¹⁰ While previous cross-sectional studies have been conducted broadly among physicians, our study stands out as it specifically focuses on the difficulties faced by surgical specialties and provides a more specialized perspective on their unique needs and challenges.

These findings suggest that telemedicine can help to bridge gaps in accessing care and improve patient outcomes by improving patient education and preparation, enabling remote optimization of health status, expanding access to expert care, facilitating virtual surgical planning, evaluating the clinical effectiveness, patient-centered outcomes, assessing patient, and provider satisfaction with telemedicine for post-operative care, reducing unnecessary hospital visits and costs. ¹¹

Telehealth is increasingly regarded as the future of medicine. Therefore, this research aims to assess the perception of telemedicine among surgeons in Jeddah, raising awareness and exploring its potential role in preoperative planning and postoperative follow-up. Given that the perception of telemedicine among surgeons in Saudi Arabia had not been fully explored yet, our study seeks to address these gaps and uncover its potential in surgical care.

Methodology

Study Design and Setting

A cross-sectional analytical study was conducted among all the surgical specialties registered under the Saudi commission for health specialties (SCFHS) employed in private as well as the public hospitals in Jeddah, Saudi Arabia. Jeddah is the largest and most populated city in the western region of Saudi Arabia. The healthcare system in the country is composed of 2 main sectors: private and public. Our study included data from both sectors. The study spanned 6 months from May 2024 to October 2024.

Study Subjects and Sampling Techniques

The inclusion criteria comprised all surgeons residing in Jeddah working under public and private hospitals. The exclusion criteria comprised of physicians who are not surgeons, not residing in Jeddah or refusing to participate. The study recruited 198 participants, from public hospitals and private hospitals. Convenience sampling was employed.

Data Collection and Study Tool

A pre-designed and validated questionnaire (attached in Supplemental Appendix 1) was distributed via data collectors in person to surgeons in various public and private hospitals through convenience sampling methods. It was based on the attitude, usage, awareness, and knowledge regarding telemedicine.

The study questionnaire consisted of 3 sections: section 1 discussed about the demographics and previous experiences with telemedicine. This section collected data on participants’ age, gender, years of clinical experience, surgical specialty, and work setting (public or private hospitals). Section 2 assessed the surgeon’s perceptions. The respondents were asked closed-ended questions regarding their knowledge and familiarity with telemedicine practices. This included yes/no binary scale questions to assess awareness and understanding of telemedicine regulations and applications in their practice. Section 3 discussed their attitudes toward telemedicine. The close-ended questions related to the attitude were assessed with the help of a 5-point Likert scale consisting of strongly agree, agree, neutral, disagree, and strongly disagree. The scale options included: Strongly Agree—Scored as 5, Agree—Scored as 4, Neutral—Scored as 3, Disagree—Scored as 2 and Strongly Disagree—Scored as 1. To classify attitudes as positive or negative, a cut-off point was established.

The questionnaire was validated and previously used in many researches.^8,12,13

Ethical Considerations

The institutional review board (IRB) granted the ethical approval (Research approval number RES-2024-0045) to ensure that the study meets all guidelines relevant to the ethical standards. Strict ethical guidelines were implemented to protect the participants’ rights and confidentiality. Confidentiality of data was guaranteed. Every respondent had an opportunity to voluntarily agree to the terms of participating in the survey given on the study survey sheet, written consent was taken at the beginning of the in-person survey. Data was collected anonymously. Additionally, they were informed that only collective results would be analyzed for study purposes and disclosed in the manuscript.

Statistical Analysis

The Statistical Package for Social Studies (SPSS), Version 26, developed by IBM, Chicago, IL, USA, was utilized to examine the information that had been collected. Descriptive statistics, including frequencies and percentages were used to summarize the socio-demographic and occupational characteristics of the participants. Chi-square tests were used for bivariate analysis to examine associations between independent variables and telemedicine usage and attitude. Statistical significance was adopted at the P-values below .05. To identify independent predictors, multivariate analysis was conducted using binary logistic regression. This method provided odds ratios (OR) and confidence intervals (CI), highlighting the effect of socio-demographic factors on the attitude and usage of telemedicine among surgeons. The overall analysis aimed to reveal key predictors of attitudes toward telemedicine and increased usage. To reduce the risk of confounding, relevant variables, such as age, gender, clinical experience, specialty, and hospital setting were included in the regression models. This adjustment allowed us to assess the independent association of each factor with telemedicine usage and attitude.

The dependent variables in this study were (1) surgeons’ attitudes toward telemedicine, categorized as positive or negative based on a predefined Likert scale cutoff, and (2) telemedicine usage, assessed through both binary (used vs not used) and ordinal measures (never, occasional, frequent usage). The independent variables included sociodemographic characteristics (age, gender), professional factors (years of clinical experience, surgical specialty, type of hospital—public or private), and telemedicine-specific variables (previous use, duration of use, frequency of use). These variables were incorporated into bivariate and multivariate analyses to explore their association with telemedicine attitudes and usage.

Results

Descriptive Analysis

This study included 198 surgeons. Study participants characteristics, as demonstrated in Table 1, showed proximity in age among participants. The majority of participants (39.4%) were between 40 and 49 years of age, a third of the participants (31.3%) were below 40 years of age, and the minority (29.3%) were above 49 years of age. Most participants were males (59.6%), and the rest (40.4%) were females. Data was collected from surgeons belonging to 13 surgical specialties. Specialized surgeons accounted for 74.2%, and the remaining (25.8%) were general surgeons. 59.1% of participants had less than 10 years of experience, whereas the remaining (40.9%) had more than 10 years’ experience. Regarding primary practice settings, more than half of the participants (57.6%) were from private hospitals, and the remaining (42.4%) were from public hospitals. More than half, accounting for 54.5%, had used telemedicine at least once. Regarding the frequency of usage, only 15.7% were frequent users, 42.4% occasional users, and 41.9% never used it. In terms of the duration of telemedicine usage, the majority of users have been using it for less than a year, 25.8% have used it for a duration of 2 to 3 years, and 14.6% have used it for more than 3 years.

Table 1.

Study Participants Socio-Demographic and Occupational Characteristics.

Variable	N	%
Age
<40 y	62	31.3
40-49 y	78	39.4
>49 y	58	29.3
Gender
Male	118	59.6
Female	80	40.4
Specialty
GS	51	25.8
SS	147	74.2
Clinical experience
<10	117	59.1
>10	81	40.9
Work setting
Public	84	42.4
Private	114	57.6
Previous usage of telemedicine
Yes	108	54.5
No	90	45.5
Frequency of telemedicine use
Never	83	41.9
Occasionally	84	42.4
Frequently	31	15.7
Duration of telemedicine use
<1 y	118	59.6
2-3 y	51	25.8
>3 y	29	14.6
Total	198	100

Abbreviations: GS, general surgeons; SS, specialized surgeons.

Figure 1 demonstrates the various concerns surgeons face when it comes to patient care, which leads to their negative attitude toward telemedicine. It is observed that over 32.8% of surgeons strongly felt they could not undertake patient examination via telemedicine, compared to only 12.6 who felt otherwise. Furthermore, the technological aspect of telemedicine also poses a challenge to surgeons’ perceptions of telemedicine, as indicated by Figure 2. It is observed that 40.91% agree to have concerns about not having reliable teleconsultation technology available to them as compared to those who say otherwise.

Figure 1.

Surgeons’ perceptions of patient care through telemedicine.

Figure 2.

Surgeons’ concern about the technological aspect of telemedicine.

Bivariate Analysis Using Chi-Square Test

The results demonstrated in Table 2, indicate a significant association between attitude and usage of telemedicine among consultant surgeons (P-value < .001). Out of those who have used telemedicine at least once previously, 50% had a positive attitude. Additionally, significant associations were observed between the frequency of usage and attitude toward telemedicine (P-value < .001). It was observed that frequent users had a less positive attitude (35.4%) in comparison to occasional users (60.7%). Out of those who never used telemedicine (41.9%), 79.5% had a positive attitude (P-value < .001). It was also noted that the duration of usage could be correlated with attitude, indicated by the observation that those who have been using for less than a year had the most positive attitude (75.4%), followed by more than 3 years (51.7%), and the least positive was shown by those who used it for 2 to 3 years (47%).

Table 2.

Association Between Socio-Demographic, Occupational Factors, the Attitude and Usage of Telemedicine Among Surgeons, Jeddah Saudi Arabia.

Variable		Total N = 198 N (%)	Attitude		P-value	Usage		P-value
			Negative N (%)	Positive N (%)		Yes (%)	No (%)
Age	<40 y	62 (31.3)	22 (35.4)	40 (64.5)	.259	33 (53.2)	29 (48.3)	.365
	40-49 y	78 (39.4)	23 (29.4)	55 (70.5)		39 (50.0)	39 (50.0)
	>49 y	58 (29.3)	25 (43.1)	33 (56.8)		36 (62.0)	22 (37.9)
Gender	Males	118 (59.6)	39 (33.0)	79 (66.9)	.410	54 (45.7)	64 (54.2)	.003*
	Females	80 (40.4)	31 (38.7)	49 (61.2)		54 (67.5)	26 (32.5)
Specialty	GS	51 (25.8)	17 (33.3)	34 (66.6)	.726	31 (60.7)	20 (39.2)	.299
	SS	147 (74.2)	53 (36.0)	94 (63.9)		77 (52.3)	70 (47.6)
Clinical Experience	<10	117 (59.1)	37 (31.6)	80 (68.3)	.187	68 (58.1)	49 (41.8)	.225
	>10	81 (40.9)	33 (40.7)	48 (59.2)		40 (49.3)	41 (50.6)
Work setting	Public	84 (42.4)	30 (35.7)	54 (62.2)	.927	34 (40.4)	50 (59.5)	.001*
	Private	114 (57.6)	40 (35.0)	74 (64.9)		74 (64.9)	40 (35.0)
Previous usage of telemedicine	Yes	108 (54.5)	54 (50.0)	54 (50.0)	<.001*	-	-	-
	No	90 (45.5)	16 (17.7)	74 (82.2)		-	-
Frequency of telemedicine use	Never	83 (41.9)	17 (20.4)	66 (79.5)	<0.001*	-	-
	Occasionally	84 (42.4)	33 (39.2)	51 (60.7)		-	-	-
	Frequently	31 (15.7)	20 (64.5)	11 (35.4)		-	-
Duration of telemedicine use	<1 y	118 (59.6)	29 (24.5)	89 (75.4)	<.001*	37 (31.3)	81 (68.6)	<.001*
	2-3 y	51 (25.8)	27 (52.9)	24 (47.0)		44 (86.2)	7 (13.7)
	>3 y	29 (14.6)	14 (48.2)	15 (51.7)		27 (93.1)	2 (6.8)

Abbreviations: GS, general surgeons; SS, specialized surgeon.

^*Significant P values < .05.

In regard to specifically the usage of telemedicine, chi-square tests revealed 2 significant P-values with socio-demographic factors. The usage of telemedicine based on gender revealed that females are more likely to use it than males, with a percentage of 67.5% and 45.7%, respectively (P-value of .003) Likewise, the usage of telemedicine by surgeons belonging to private hospitals was higher compared to those in public settings, with a respective percentage of 64.9% and 40.4% (P-value of .001).

To summarize the factors influencing attitude, significant associations were observed between positive attitude and previous telemedicine use (P < .001), frequency of use (P < .001), and duration of usage (P < .001) although the frequency and duration did not show any significant relation in the binary logistics regression test. Significant predictors of usage included female gender (P = .003) and employment in the private sector (P = .001) although these were not significant in the binary logistic test. Non-significant factors included age, specialty, and years of clinical experience, which did not show any statistically meaningful associations in either outcome.

Binary Logistic Regression Analysis

Binary logistic regression statistical model findings indicated in Table 3 revealed a significant relation between the surgeons’ attitude and prior use of telemedicine (P-value .007). Surgeons who used telemedicine previously presented with a higher likelihood of having positive attitudes toward it (OR = 5.688; CI = 1.593-20.313). Significant associations with attitude were not observed with other factors such as years of telemedicine use and frequency of telemedicine in preoperative and postoperative consultations. Although not significant, it was noted that surgeons who used telemedicine for more than 3 years had slightly more positive attitude (OR = 0.897, 95% CI: 0.303-2.649) compared to those who used it for 2 to 3 years (OR = 0.529, 95% CI: 0.220-1.274).

Table 3.

Binary Logistics Regression Analysis of the Socio-demographic and Occupational Predictors of Telemedicine Attitudes and Usage by Surgeons, in Jeddah, Saudi Arabia.

Variable		Attitudes			Usage
		OR	95% CI	P-value	OR	95% CI	P-value
Age	<40 y (ref)	1			1
	40-49 y	1.694	0.746-3.850	.208	1.279	0.288-5.681	.747
	>49 y	1.413	0.554-3.607	.470	2.136	0.370-12.338	.396
Gender	Male (ref)	1			1
	Female	0.987	0.505-1.930	.970	3.126	0.913-10.705	.070
Specialty	GS (ref)	1			1
	SS	0.664	0.305-1.444	.301	1.045	0.271-4.027	.949
Clinical experience	<10 (ref)	1			1
	>10	0.565	0.261-1.221	.147	0.381	0.088-1.647	.196
Work setting	Public (ref)	1			1
	Private	1.295	0.639-2.628	.473	1.485	0.470-4.687	.500
Previous usage of telemedicine	No (ref)	1			-	-	-
	Yes	5.688	1.593-20.313	.007*	-	-	-
Frequency of telemedicine use	Never (ref)	1			-	-	-
	Occasionally	1.758	0.472-6.548	.400	-	-	-
	Frequently	0.717	0.156-3.290	.669	-	-	-
Duration of telemedicine use	<1 y (ref)	1			1
	2-3 y	0.529	0.220-1.274	.156	1.728	0.441-6.763	.432
	>3 y	0.897	0.303-2.649	.844	3.924	0.611-25.226	.150

Abbreviations: CI, confidence interval; GS, general surgeons; OR, odds ratio; SS, specialized surgeons.

^*Significant P values < .05.

Longer use of telemedicine was associated with a higher likelihood of continued use, particularly among those with over 3 years of experience though it was not significant (OR = 3.924, 95% CI: 0.611-25.226; P = .150). In contrast age, specialty and years of experience were found to have no significant associations in this analysis.

To summarize, binary logistic regression revealed that previous telemedicine use (P = .007) was the only significant predictor of future telemedicine use and positive attitude. Other factors, including age, gender, specialty, experience, and work setting, were not significant.

Discussion

The integration of telemedicine in healthcare is a revolutionary shift as it enables remote consultations and helps in easy access to medical services. The adoption of these new services of telemedicine specifically among surgeons, since they play a critical part in the healthcare sector, would lead to special potential benefits and a new set of challenges.

This study is a cross-sectional study conducted for the evaluation of the attitude and usage of telemedicine among surgeons in Jeddah. Our study showed that the rate of adoption in private practice is higher than in the public health setting although not significant. The results of this aligns with prior research by Bashir et al in 2023 among physicians in Riyadh, a city in the central region of Saudi Arabia. These findings indicate that private practitioners typically may have an advantage in telemedicine adoption because of fewer administrative restrictions and quicker-moving infrastructure. ¹⁴ This notable disparity between the public and private sectors in our research indicates barriers in the Saudi public health system that need more focus for improvement.

Our study results indicated that only half the surgeons’ attitude toward the usage of telemedicine was positive. This is in contrast to the findings by Bashir et al, done during the pandemic of COVID-19 among physicians had indicated much higher positive attitudes. ¹⁴ In contrast, the lower positive attitude revealed in our study could partly be due to the nature of the surgical specialty, where telemedicine does not fully allow procedural and hands-on needs in the examination of patients. Also, telemedicine was an extremely significant and helpful tool during the pandemic, where social distancing hindered frequent in-person consultations. The lower positive attitude in our study could also be because it has been conducted in a post-COVID setting compared to previous studies, which were conducted primarily in a pandemic setting.

Interestingly, surgeons who had used telemedicine for less than 1 year showed the highest positive attitude, followed by those who had used it for more than 3 years. This contrasts with our initial assumption that longer duration leads to more favorable perception, suggesting that initial exposure might create enthusiasm or optimism, which may taper with time due to challenges encountered. However, binary logistic regression confirmed that previous usage was the only statistically significant predictor of a positive attitude. This supports earlier observations, such as those made by Eltahir et al in 2021, that familiarity increases confidence in using telemedicine. ¹⁵ This finding also suggests that their positive attitudes likely developed through personal experiences with telemedicine, rather than from biased opinions or misinformation. ¹⁶ On the contrary, our study found that frequent users had a less positive attitude compared to occasional users, which could imply that frequent use might expose limitations or frustrations with the system, impacting attitudes.

Although not significant, it was found in our study that female surgeons used and were more likely to continue the use of telemedicine more compared to male surgeons. This corresponds to the existing patterns found in the literature, where according to a study conducted in Phillips et al in 2024, showed that female doctors compared to their male colleagues, had a greater susceptibility to adopt telemedicine in their practice. ¹⁷ As per a previous study by Malacon et al, compared to their male surgeons, female surgeons wrote longer patient notes and used Electronic Health Records (EHR) outside of working. ¹⁸ All of these findings imply that gender-specific factors, such as cultural and societal reasons, women’s enthusiastic and positive attitude toward new innovations and technology, and work-family life balancing considerations, may have a positive impact on the adoption of telemedicine among females. It is, therefore, recommended that further research be done on the gender-specific factors and implications of integrating telemedicine into the health system. An intriguing observation in our study is that some non-users of telemedicine demonstrate positive attitudes, implying an appreciation of its usefulness despite not using it. This is consistent with findings by Albarrak et al, in 2019, who suggested interest can be converted into practice through awareness campaigns and the right training. It also noted the main barriers toward telemedicine involve concern for quality of care and training; both of these issues need to be solved in order to encourage wider use. ¹⁰

The acceptance of telemedicine is not a simple process, as evidenced by differences in knowledge and attitudes in literature reviews. For instance, Bashir et al, in 2023 reported a favorable attitude among medical professionals, but Eltahir et al, in 2021 reported that oral and maxillofacial surgeons had little awareness of telemedicine. These differences, again, demand specialty-based and setting-based strategies for training and successful adoption of telemedicine.^14,15

Our study investigates in depth to find the major concerns that physicians perceive about telemedicine and its usage, mainly on 2 grounds: providing adequate patient care and the technological aspects regarding telemedicine itself. As shown in Figure 1, a significant portion of surgeons believed they could not perform a patient evaluation via telemedicine, and many were also worried about their patients having access to dependable internet as indicated by Figure 2. These findings also align with another study by Dubin et al, where a significant perceived barrier was the patients lack of access to necessary technology. ¹⁹

Our findings are in line with the global trend, showing that digital technologies are changing surgical practice and decision-making. On one hand, Parveen et al highlighted that telemedicine contributes to more efficient preoperative assessment pathways; on the other hand, Imran et al showed that technology-driven tools are increasingly enhancing the abilities of surgeons.^20,21 These insights support the relevance of our investigation into the acceptance of telemedicine by surgeons.

Our study has important implications on several grounds. First, it reflects the current local state of the attitude and usage of telemedicine. These findings could guide policymakers to compare the current state of telemedicine in KSA with global trends, lay out training programs, and developmental plans to incorporate telemedicine into the KSA healthcare system. Secondly, the marked difference in the adoption rate between private and public healthcare settings underlines some potential systemic needs for development in the Saudi Arabian healthcare system that have to be addressed. However, as private sector employment was not a significant predictor in regression analysis, infrastructural and cultural elements should also be considered. Again, the correlation of the duration of telemedicine use with positive attitudes underlines the importance of long-term support and training in the use of telemedicine. Gender differences in usage trends show that female surgeons are more receptive to telemedicine. This raises additional intriguing further research concerns about whether gender-specific factors like culture, and an openness to new ideas among females have impacted the use of technology in healthcare. The major concerns regarding telemedicine use can be improved by enhancing the technological availability and providing adequate training programs to both surgeons and patients. In addition, concerns regarding patient care should be solved at a hospital level and depending on the specialty.

However, as with every study, this paper also has several limitations. First, due to convenience sampling, selection bias might have occurred because those surgeons who were more accessible or more interested in telemedicine would have participated. Thus, this sample may not be representative of the broader population in Jeddah or Saudi Arabia. The fact that our study was conducted in Jeddah only, raises questions of generalizability to other regions with different health infrastructures or patterns of telemedicine adoption. Due to the relatively few surgeons in each subspecialty, including but not limited to neurosurgeons and orthopedic surgeons nationwide, we were unable to analyze each specialty separately. We have combined all subspecialties together to preserve the statistical validity, which may mask specialty-specific differences. Consequently, our study does not capture differences in telemedicine attitudes and usage among individual specialties. However, future research should aim to focus on specialty-specific analyses once a sufficient sample size in terms of specialized surgeons is available. Third, the cross-sectional design precludes any causal inference. Despite prior exposure to telemedicine being associated with more positive attitudes, the direction of the relationship cannot be drawn. Longitudinal studies are required to clarify the causality. Fourth, although we assessed the frequency and duration of telemedicine use, we did not investigate long-term sustainability factors such as clinician burnout, technology fatigue, and workflow adaptation due to the cross-sectional design of the study. Finally, while technological challenges were assessed, other psychosocial factors such as surgeon trust in telemedicine, patient engagement, and confidence in virtual clinical assessment were not explored in detail. Future qualitative or mixed-methods studies should delve further into these dimensions.

However, the study achieved a full response rate from various centers across the study area, which helps to support the reliability of the results within the sampled group. In summary, while attitudes and usage patterns vary, previous telemedicine use stands out as the most significant predictor of a positive attitude. The widespread application and positive attitude toward telemedicine in surgical specialties in Jeddah, especially in private health care, is promising. Telemedicine can be further included into surgical practice with the right implementation of infrastructure, technological development, and training among healthcare staff to adopt telemedicine efficiently and raise the standard and accessibility of the best care for Saudi Arabian patients from the comfort of their homes.

Conclusion

Telemedicine among surgeons in Saudi Arabia was found to be linked primarily with its prior usage. Although not significant, surgeons in private practice are more likely to favor telemedicine, those in public practice are still in the process of integrating it into their workflows and explore its potential. Similarly, female surgeons generally exhibited more positive attitudes toward telemedicine integration in surgical practices than male surgeons. Attitudes toward telemedicine appear to be most significantly associated with its recent use; surgeons who reported more frequent use in the past 3 months tended to express greater satisfaction with the modality. Although the statistical analysis did not identify training and infrastructure as significant predictors, we emphasize their importance as enabling factors that can further support telemedicine integration, particularly in public sector hospitals where uptake remains lower. Targeted awareness initiatives, structured training programs, and strategic investments in technology infrastructure may therefore help expand telemedicine’s potential across the broader surgical field in Saudi Arabia.