A.P. Bain1,3, L. Matthews1, R.W. Turer2,3, B.R. Bruns1, A. Tannous1, D.F. Butler1 1University Of Texas Southwestern Medical Center, Surgery, Dallas, TX, USA 2University Of Texas Southwestern Medical Center, Emergency Medicine, Dallas, TX, USA 3University Of Texas Southwestern Medical Center, Clinical Informatics Center, Dallas, TX, USA
Introduction:
Post-operative telehealth has been shown to be sufficient after general surgery. Disparities in race, ethnicity, and socioeconomic status have been identified as barriers to telehealth in the general population. The current study characterizes the state of post-operative telehealth use for patients undergoing laparoscopic cholecystectomy. When comparing those who use post-operative telehealth versus in-person visits, we hypothesize that post-operative emergency department (ED) and hospital encounters will be equivalent at 30-days.
Methods:
Cosmos, a community collaboration of health systems representing over 262 million patient records from over 1,557 hospitals and 35,400 clinics, was queried. Patients greater than 18 years of age were identified using current procedural terminology (CPT) codes for laparoscopic cholecystectomy and were stratified by post-operative telehealth use, within 30-days of index admission. Demographic variables including age, race, sex, ethnicity, Social Vulnerability Index (SVI), Rural Urban Commuting Area Codes (RUCA) grouped to urban vs rural, and patient portal use were collected. The outcome of interest was 30-day ED or hospital use after first post-operative visit. Patients with ED or hospital encounters prior to initial outpatient visit were excluded. Chi-square test, Wilcoxon signed rank test, and multivariable logistic regression was used where appropriate. Significance was set at p<0.05.
Results:
In 2024, 68,832 patients were identified with a mean age of 51 (IQR 36-66). Patients were predominantly female (70%), white (71%), non-Hispanic (85%), primarily English speaking (91%), and lived in an urban area (81%). 3,857 patients (5.6%) had a telehealth visit as their first post-op encounter. In total, 5,258 patients (7.6%) received some postoperative telehealth. Initial post-op telehealth visit was associated with a similar rate of post follow-op ED visit or hospitalization (4.5% vs 3.9%, p=0.06). On multivariable logistic regression, telehealth use was associated with urban area (OR 1.51, CI 1.40-1.63), non-activated patient portal account (OR 1.23, CI 1.17-1.3), African American race (OR 1.16, CI 1.06-1.27), Hispanic ethnicity (OR 1.2, CI 1.1-1.31), female sex (OR 1.26, CI 1.17-1.32) (Figure 1). Older age (OR 0.992, CI 0.99-0.993), increased SVI percentile (OR 0.70, CI 0.64-0.78), and Spanish language (OR 0.84, CI 0.75-0.96) preference were associated with decreased use (Figure 1).
Conclusion:
For patients undergoing laparoscopic cholecystectomy, post-operative telehealth appears adequate follow up when assessing post-visit healthcare utilization. Unfortunately, barriers remain for many patients and the technology is not widely utilized. Differences in use may be explained by patient or health system preference for in person visits or related to limitations in access or trust in this newer visit modality. Given disparities in age, language, location, and social vulnerability, targeted interventions may increase telehealth participation.