Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P<0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P<0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally.

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound. International Cohort Study, and Systematic Review with Meta-analysis / Glasbey, James; Trout, Issi; Adeyeye, Victoria; Ademuyiwa, Adesoji; Adisa, Adewale; Bhatt, Alisha; Biccard, Bruce; Brocklehurst, Peter; De La Croix Allen Ingabire, Jean; Moïse Dossou, Francis; Durán, Irani; Dutta, Rohini; Ghosh, Dhruva; Gyamfi, Frank; Hardy, Pollyanna; Hyman, Gabriella; Jain, Ritu; Kadir, Bryar; Knight, Stephen; Ladipo-Ajayi, Oluwaseun; Lawani, Ismail; Lawani, Souliath; Lillywhite, Rachel; Macefield, Rhiannon; Magill, Laura; Martin, Janet; Mathers, Jonathan; Mclean, Kenneth; Mistry, Punam; Mittal, Rohin; Moore, Rachel; Morton, Dion; Ntirenganya, Faustin; Ofori, Emmanuel; Pearse, Rupert; Peón, Alberto; Pinkney, Thomas; Ramos de la Medina, Antonio; Ronald, Tubasiime; Roman, David; Simoes, Joana; Slade, Anita; Tabiri, Stephen; Smith, Donna; Harrison, Ewen; Bhangu, Aneel; Glasbey, James; Trout, Issi; Bhangu, Aneel; Verjee, Azmina; Runigamugabo, Emmy; O Ademuyiwa, Adesoji; O Adisa, Adewale; Lorena Aguilera, Maria; Altamini, Afnan; Alexander, Philip; W Al-Saqqa, Sara; Borda-Luque, Giuliano; Cornick, Jen; Costas-Chavarri, Ainhoa; M Drake, Thomas; J Fergusson, Stuart; Edward Fitzgerald, J; Glasbey, James; C Allen Ingabire, J; Ismaïl, Lawani; Jaffry, Zahra; Khairy Salem, Hosni; Khatri, Chetan; Kirby, Andrew; Theophilus Teddy Kojo, Anyomih; Carmela Lapitan, Marie; Lilford, Richard; L Mihaljevic, Andre; Mohan, Midhun; Morton, Dion; Zeta Mutabazi, Alphonse; Nepogodiev, Dmitri; Ntirenganya, Faustin; Ots, Riinu; Pata, Francesco; Pinkney, Thomas; Poškus, Tomas; Uzair Qureshi, Ahmad; Ramos-De la Medina, Antonio; Rayne, Sarah; Recinos, Gustavo; Søreide, Kjetil; A Shaw, Catherine; Shu, Sebastian; Spence, Richard; Smart, Neil; Tabiri, Stephen; Lilford, Richard; Morton, Dion; M Harrison, Ewen; Bhangu, Aneel; Marta Modolo, Maria; Iyer, Dushyant; King, Sebastian; Arthur, Tom; Nazmum Nahar, Sayeda; Waterman, Ade; Ismaïl, Lawani; Walsh, Michael; Agarwal, Arnav; Zani, Augusto; Firdouse, Mohammed; Rouse, Tyler; Liu, Qinyang; 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[10.1097/SLA.0000000000005506]

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound. International Cohort Study, and Systematic Review with Meta-analysis

Gaetano Gallo;Genoveffa Balducci;Diego Coletta;Tommaso Bocchetti;
2023

Abstract

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P<0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P<0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally.
2023
telemedicine; surgical wound; postdischarge
01 Pubblicazione su rivista::01a Articolo in rivista
Use of Telemedicine for Post-discharge Assessment of the Surgical Wound. 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Maulana Arsyad, Hasbi; Adhitama, Novia; Saditya Jeo, Wifanto; Sutandi, Nathania; Clarissa, Audrey; Anggita Gultom, Phebe; Billy, Matthew; Haloho, Andreass; Amandito, Radhian; Johanna, Nadya; Lee, Felix; Mohd Nurrahman Radin Dorani, Radin; Glynn, Martha; Alherz, Mohammad; Goh, Wennweoi; A Shiwani, Haaris; Sproule, Lorraine; C Conlon, Kevin; Bala, Miklosh; Kedar, Asaf; Turati, Luca; Bianco, Federica; Steccanella, Francesca; Gallo, Gaetano; Trompetto, Mario; Clerico, Giuseppe; Sammarco, Giuseppe; Sacco, Rosario; Benevento, Angelo; Pata, Francesco; Giavarini, Luisa; Cesare Giglio, Mariano; Bucci, Luigi; Pagano, Gianluca; Sollazzo, Viviana; Peltrini, Roberto; Luglio, Gaetano; Birindelli, Arianna; Di Saverio, Salomone; Tugnoli, Gregorio; Angel Paludi, Miguel; Mingrone, Pietro; Pata, Domenica; Selvaggi, Francesco; Selvaggi, Lucio; Pellino, Gianluca; Di Martino, Natale; Curletti, Gianluca; Aonzo, Paolo; Galleano, Raffaele; Berti, Stefano; Francone, Elisa; Boni, Silvia; Lorenzon, Laura; Lo Conte, Annalisa; 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[10.1097/SLA.0000000000005506]
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