For presurgical appointments leading up to bariatric (weight-loss) surgery, people who got their care remotely through telemedicine were not worse off based on a range of outcomes related to the surgery, according to a new study published in the journal JAMA Network Open.
Bariatric surgery has been shown to have a range of benefits among people with both obesity and type 2 diabetes — and the risks are considered to be low enough that the latest official guidelines recommend the surgery for more people than ever before. The surgery has been shown to promote remission of type 2 diabetes and prediabetes, meaning that blood glucose levels are normal without taking any glucose-lowering drugs. Bariatric surgery is also linked to a lower risk for certain cancers, a lower risk for kidney disease, improved mobility, a lower risk for diabetic retinopathy (eye disease), and a lower risk for death from cardiovascular causes. These improved outcomes may not be due only to bariatric surgery, since people who have the surgery also tend to have healthier lifestyle behaviors.
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For the latest study, researchers looked at a group of 1,182 people who underwent bariatric surgery at an academic hospital in the United States. A subset of 925 participants underwent an in-person presurgical evaluation between January 2018 and December 2019, while 257 had a remote evaluation using telemedicine — in this case, a video link — between July 2020 and December 2021. The switch to telemedicine was made, of course, due to the COVID-19 pandemic. Participants in the telemedicine group tended to be younger than those in the in-person group, with an average age of 40.8 compared with 43.0. The telemedicine group was also 89.5% female, compared with 82.8% of the in-person group. These differences may reflect age-based or sex-based differences in willingness to proceed with bariatric surgery during the pandemic.
Telemedicine outcomes similar to in-person visits for bariatric presurgical appointments
The researchers looked at a range of outcomes in both groups related to bariatric surgery, with participants followed for 60 days following the surgery. For those who had a remote evaluation, the average operating room delay was 7.8 minutes, compared with 4.2 minutes for those who had an in-person evaluation. The average length of the surgery was 134.4 minutes for those with a remote evaluation, compared with 105.3 minutes, and the average length of the hospital stay was 1.9 days compared with 2.1 days. The rate of major adverse events (such as infection or other surgical complications) within 30 days was 3.8% in the remote group and 1.6% in the in-person group, and from days 31 to 60 it was 2.2% compared with 1.6%. The rate of emergency room visits within 30 days was 18.8% in the remote group compared with 17.9% in the in-person group, and the rate of hospital readmission within 30 days was 10.1% compared with 6.6%.
In all of these areas, the remote evaluation group was considered to have outcomes that were not worse in any meaningful way than the group than had an in-person evaluation. Only one person died, which occurred within 30 days of surgery and was a member of the in-person group, as noted in an article on the study at MedPage Today.
“Telemedicine may expand the reach of bariatric surgery and narrow disparities for historically disinvested patient populations,” the researchers wrote. “Further investigations should focus on geographical differences between telemedicine and traditional, in-person patient populations and ensure both patient and clinician satisfaction” with remote visits.
Want to learn more about telehealth? read “Diabetes and Telehealth: Tips for a Successful Virtual Visit.”
Want to learn more about bariatric surgery and type 2 diabetes? Read “Is Bariatric Surgery for You?” and “Bariatric Surgery and Diabetes: Questions and Answers.”
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