The Efficacy of Telemedicine Versus In-Person Education for High-Risk Patients Undergoing Primary Total Joint Arthroplasty |
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| Institution: | 1. Orthopedic Research Fellow, Anne Arundel Medical Center, Annapolis, Maryland;2. Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland;3. Anne Arundel Medical Center, Annapolis, Maryland;4. Orthopedic and Surgery Research, Anne Arundel Medical Center, Annapolis, Maryland;1. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom;2. Clinic for Orthopaedics and Trauma Surgery, University of Heidelberg, Heidelberg, Germany;3. Nuffield Orthopaedic Centre, Oxford, United Kingdom;4. Clinic for Orthopaedics Paulinenhilfe, Diakonie-Klinikum Stuttgart, Stuttgart, Germany;1. Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana;2. LSUHSC Department of Orthopedic Surgery, New Orleans, Louisiana;3. Ochsner Sports Medicine Institute, Jefferson, Louisiana;1. Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana;2. Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan;1. Dignity Health Medical Group, Arizona Creighton University School of Medicine- Phoenix, Phoenix, Arizona;2. Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan;3. Northwell Health Orthopaedic Institute at Lenox Hill, New York, New York;4. Department of Orthopedic Surgery, St. Joseph Mercy Hospital, Ann Arbor, Michigan |
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| Abstract: | BackgroundWhile multiple studies have demonstrated the positive impact of preoperative education on total joint arthroplasty (TJA) outcomes, the traditional method of conducting in-person individualized counseling or group education may limit access to these resources for a subset of the population. This study aimed to evaluate the use of preoperative telemedicine and in-person educational programs for primary TJA patients to determine if the utilization of telemedicine is inferior to in-person education in high-risk populations.MethodsA retrospective chart review of all “high-risk” patients undergoing primary unilateral TKA or THA by 1 of 10 board-certified surgeons at a single institution over 1 year was performed. Patients were prospectively classified as high-risk based on race/ethnicity, comorbidities, and socioeconomic and psychosocial factors. Demographics, comorbidities, and hospital outcomes were compared between patients receiving preoperative nurse navigator education via telemedicine versus those receiving face-to-face education.ResultsWhen comparing the interventions, telemedicine education was noninferior to face-to-face visits. No significant differences between postoperative length of stay, discharge home, 30-day emergency department return, or 30-day readmission rates were noted. Within the telemedicine group, patients who received video consultations were found to be 6 times more likely to be discharged home after surgery (odds ratio (OR): 5.95, 95% confidence interval (CI): 2.00 to 25.49; P = .004) and less likely to have a 30-day readmission than the phone consultations (OR: 0.36, 95% CI: 0.12 to 0.94: P = .050).ConclusionThis study demonstrates that telemedicine is not inferior to in-person preoperative education for patients undergoing unilateral TJA, although video-based consultation may improve outcomes over phone-only education. |
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| Keywords: | telemedicine racial disparities hip arthroplasty knee arthroplasty length of stay readmission |
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