Does video-based postdischarge virtual follow-up provide noninferior care compared with in-person follow-up?
In this randomized clinical trial that included 432 adults, the postdischarge hospital encounter proportion after minimally invasive appendectomy or cholecystectomy was not significantly different (12.8% for virtual vs 13.3% for in person). Virtual visits provided equal amount of time with the clinician but significantly decreased the overall time commitment for postdischarge visits.
Video-based postdischarge virtual visits were not associated with increased use of care and saved time for the patient.
Postdischarge video-based virtual visits are a growing aspect of surgical care and have dramatically increased in the setting of the coronavirus disease 2019 (COVID-19) pandemic.
To evaluate the outcomes of all-cause 30-day hospital encounter proportion among patients who have a postdischarge video-based virtual visit follow-up compared with in-person follow-up.
Design, Setting, and Participants
Randomized, active, controlled noninferiority trial in an urban setting, including patients from a small community hospital and a large, tertiary care hospital. Patients who underwent minimally invasive appendectomy or cholecystectomy by a group of surgeons who cover emergency general surgery at these 2 hospitals were included. Patients undergoing elective and nonelective procedures were included.
Patients were randomized in a 2:1 fashion to video-based virtual visit or in-person visit.
Main Outcomes and Measures
The primary outcome is the percentage of patients with 30-day hospital encounter, and we hypothesized that there would not be a significant increase in the 30-day hospital encounter proportion for patients who receive video-based virtual postdischarge care compared with patients who receive standard (in-person) care. Hospital encounter includes emergency department visit, observation, or inpatient admission.
A total of 1645 patients were screened; 289 patients were randomized to the virtual group and 143 to the in-person group. Fifty-three patients crossed over to the in-person follow-up group. The percentage of patients who had a hospital encounter was noninferior for virtual visits (12.8% vs 13.3% for in-person, Δ 0.5% with 1-sided 95% CI, −∞ to 5.2%). The amount of time patients spent with the clinician (mean of 8.4 minutes virtual vs 7.8 minutes in-person; P = .30) was not different, but the median overall postoperative visit time was 27.5 minutes shorter (95% CI, −33.5 to −24.0).
Conclusions and Relevance
Postdischarge video-based virtual visits did not increase hospital encounter proportions and provided shorter overall time commitment but equal time with the surgical team member. This information will help surgeons and patients feel more confident in using video-based virtual visits.
ClinicalTrials.gov Identifier: NCT03258177
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Harkey K, Kaiser N, Zhao J, et al. Postdischarge Virtual Visits for Low-risk Surgeries: A Randomized Noninferiority Clinical Trial. JAMA Surg. Published online January 13, 2021. doi:10.1001/jamasurg.2020.6265
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