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Original Investigation
January 13, 2021

Postdischarge Virtual Visits for Low-risk Surgeries: A Randomized Noninferiority Clinical Trial

Author Affiliations
  • 1Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
  • 2Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina
  • 3Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia
JAMA Surg. Published online January 13, 2021. doi:10.1001/jamasurg.2020.6265
Key Points

Question  Does video-based postdischarge virtual follow-up provide noninferior care compared with in-person follow-up?

Findings  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.

Meaning  Video-based postdischarge virtual visits were not associated with increased use of care and saved time for the patient.

Abstract

Importance  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.

Objective  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.

Interventions  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.

Results  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.

Trial Registration  ClinicalTrials.gov Identifier: NCT03258177

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