Telemedicine consultations in oral and maxillofacial surgery

doi:10.1016/S0278-2391(99)90226-4

Journal of Oral and Maxillofacial Surgery

Volume 57, Issue 2, February 1999, Pages 136-138

https://doi.org/10.1016/S0278-2391(99)90226-4 Get rights and content

Abstract

Purpose: The purpose of this study was to evaluate the efficiency of telemedicine consultation for preoperative assessment of patients.

Patients and Methods: A retrospective study of 43 patients was done to evaluate the efficiency of telemedicine consultation in adequately assessing patients for dentoalveolar surgery with general anesthesia and nasotracheal intubation. Efficiency was defined as the ability to conduct surgery with general anesthesia at the immediately following clinic appointment without the need for further preoperative testing, evaluation, or consultation. Thirty-five of these patients were subsequently treated.

Results: Ninety-five percent (33) of patients were able to undergo surgery with general anesthesia at the immediate appointment, and 100% of patients were assessed correctly, using telemedicine consultation. Two of the patients were assessed as American Society of Anesthesiologists Class III during telemedicine consultation and required further evaluation before surgery could be scheduled. No surgical procedure was canceled, and there were no anesthetic complications attributable to inadequate preoperative assessment of patients during telemedicine consultation.

Conclusions: This study confirms that telemedicine consultations are as reliable as those conducted by traditional methods. Because of the reorganization of health care and the ways it is financed, it may be more economical to move data from place to place than to move doctors from place to place. Telecommunication is an efficient and cost-effective mechanism to provide preoperative evaluation in situations in which patient transport is difficult or costly.

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Cited by (59)

Telemedicine in OMFS: a literature review of its potential and future prospects
2024, British Journal of Oral and Maxillofacial Surgery
In the backdrop of telemedicine's rise, this review explores its integration into oral and maxillofacial surgery (OMFS), especially given the healthcare access challenges faced by nearly 20% of the rural population in the United States of America. The study underscores the potential of telemedicine to address disparities in access to OMFS care, particularly in rural areas, by improving patient care, reducing travel needs, and fostering collaborative diagnosis and treatment. The findings advocate for broader adoption of telemedicine in OMFS, contingent upon supportive policy and infrastructure changes.
Accuracy of Telemedicine Consultations in Oral and Maxillofacial Surgery During the COVID-19 Pandemic
2023, Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
Rollert et al studied 35 patients retrospectively to estimate the effectiveness of telemedicine consultations for preoperative assessments.10 In their study, efficiency was defined as the ability to complete the surgery with GA at the immediate following appointment without the need for additional preoperative testing, evaluation, or consultation.10 The authors noted that 33 out of 35 (94%) patients were able to successfully undergo a procedure with GA at the appointment immediately following consultation via telemedicine.10
Telemedicine has been an emerging trend over the past few years and has seen an exponential rise due to the COVID-19 pandemic. The purpose of the present study was to determine the accuracy of planned oral and maxillofacial surgery (OMS) procedures for patients seen initially by telemedicine in the department of OMS during the pandemic.
This was a retrospective cohort study. Record review of all patients who received telemedicine consultations during the pandemic time frame of March 1, 2020, to March 1, 2021, was performed. The primary outcome was the accuracy of the planned OMS procedure. Accuracy was defined as the ability to conduct the planned surgery with chosen anesthesia (local anesthesia, diazepam + local anesthesia, intravenous sedation, general anesthesia) at the immediate follow-up appointment without the need for further preoperative testing, evaluation, and consultation. The secondary outcomes were to determine the change in surgical plan, anesthesia plan, and medical plan. Predictor variables included age at the time of telemedicine consultation, gender, race, ethnicity, and the type of consult. Descriptive statistics and logistic regression analysis were executed.
The study sample comprised 286 (64.56%) females and 157 (35.44%) males. The age range of the study population was 9 to 92 years, with a mean age of 33.88 years (standard deviation = 16.29 years). In the cohort of 443 patients who obtained telemedicine consultations, 98.19% were successfully treated at the following appointment. Four hundred thirty-one (97.3%) out of the 443 telemedicine consults pertained to dentoalveolar concerns. Logistic regression analysis showed that neither age nor gender had significant effects on the change of surgical and anesthesia plans.
Telemedicine can be effectively utilized in performing consultations for routine OMS procedures, especially dentoalveolar surgeries. Telemedicine consultation can also be used to conduct a preoperative assessment to determine anesthesia and setting of care. However, given the lack of control group and the observational nature of this study, the results must be interpreted with caution.
Promoting and developpping telemedicine before surgery
2022, Praticien en Anesthesie Reanimation
La téléconsultation d’anesthésie est autorisée pour tous les patients et toutes les chirurgies et remboursée par l’assurance maladie. Le système se doit de préserver la confidentialité des échanges. La consultation fait l’objet d’un compte rendu inclus dans le dossier médical du patient. Son coût économique est inférieur et son bilan carbone est moindre que celui d’une consultation présentielle. La consultation d’anesthésie repose pour une grande partie sur l’interrogatoire qui est réalisable à distance. Une teleconsultation peut se transfomer en convocation présentielle si un examen physique semble nécéssaire ou recourir à un autre avis spécialisé ( ex: cardiologue).
The teleconsultation is cost saving and reduces carbon footprint. It allows acceptable evaluation of preoperative patients scheduled for anaesthesia. It is reimbursed by the national insurance system. Preservation of confidentiality is required. A report of the conclusions in the patient’ medical file is mandatory. Physical examination is not possible but can be done on hospital admission and complementary investigations commonly provide more information about the patient’ medical status. Thanks to COVID pandemic, there is an opportunity to promote teleconsultation before surgery.
Implementation of telemedicine preoperative visits for abortion procedures through 18 weeks gestation at a Northern California hospital-based center
2022, Contraception
Describe the implementation of a preoperative telemedicine program at a Northern California hospital-based center for abortion procedures requiring cervical preparation.
We implemented a pilot program using telemedicine for preoperative visits for patients needing cervical preparation prior to an abortion procedure from 12 to 18 weeks. We required ultrasonography for gestational age documentation in addition to placental localization in patients with a prior cesarean delivery. We prescribed misoprostol for cervical preparation for patients undergoing the telemedicine preoperative visit; in-person preoperative visits typically involve placement of osmotic dilators. Secondarily, we surveyed patients who had telemedicine and in-person preoperative visits to compare their preoperative experiences.
Implementation required 8 months of multidisciplinary meetings. From March 2018 through March 2019, we received 200 abortion referrals at 12 to 18 weeks gestation. Of these 200 patients, 119 did not meet telemedicine eligibility criteria, most commonly due to inability to obtain required ultrasonography (n = 89 [75%]). Of the remaining 81 patients, 43 scheduled telemedicine visits of which 41 initiated and 38 (88%) completed the visits. Twenty-one (55%) telemedicine encounters had no or minor technical difficulties. Thirty-one of 34 (91%) telemedicine and 91 of 108 (84%) in-person visit patients expressed high satisfaction with their preoperative appointment (p = 0.4); none reported dissatisfaction. Patients chose the telemedicine visit primarily for convenience and transportation concerns.
A multidisciplinary team is essential for the successful implementation of a preoperative telemedicine program for procedural abortion care. Patients reported high satisfaction and reduced logistical burdens with the telemedicine option.
Telemedicine preoperative visits for abortion procedures at 12 to 18 weeks gestation may improve access to abortion care, reduce patient burdens, and provide an alternative encounter option which may improve the patient experience.
Telemedicine and digital transformation in anesthesiology
2022, Revista Espanola de Anestesiologia y Reanimacion
Virtual preoperative assessment in surgical patients: A systematic review and meta-analysis
2021, Journal of Clinical Anesthesia
Citation Excerpt :
Seven studies were retrospective cohort studies [16,40,42–44,47,48], five were prospective cohort [39,41,45,46,49], and there was one case series [38], one randomized controlled trial [12], and one cross-sectional study [50]. All of the studies compared virtual care to in-person preoperative assessment, with the exception of four studies without a comparison group [47–50]. The average time between preoperative assessment and surgery was in the range of 1–34 days [39,47,48].
Preoperative assessment is a standard evaluation, traditionally done in-person in a preanesthesia clinic, for patients who will be undergoing a procedure involving anesthesia. Given the increased adoption of virtual care during the coronavirus disease 2019 (COVID-19) pandemic, the purpose of this systematic review and meta-analysis is to review the effectiveness of virtual preoperative assessment for the evaluation of surgical patients.
Systematic review and meta-analysis.
MEDLINE (Ovid), MEDLINE InProcess/ePubs, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were searched from the initial coverage of the respective database to May 2021. A manual citation search of Google Scholar and PubMed was conducted to identify missed articles. Continued literature surveillance was done through July 2021.
Patients aged 18 years and older undergoing virtual preoperative anesthesia assessment.
Virtual preoperative assessment.
Surgery cancellation rates, patient experience, resources saved, staff experience, success in using the data collected to diagnose and manage patients.
Fifteen studies (n = 31,496 patients) were included in this review. The average age of patients was 58 ± 15 years, and 47% were male. Virtual preoperative assessment resulted in similar surgery cancellation rates compared to in-person evaluation, with a pooled cancellation rate of 2% (95% confidence interval [CI]: 1–3%). Most studies reported a positive patient experience, with a pooled estimate of 90% (95% CI, 81–95%). There was a high success rate in using the information collected with virtual care, in the range of 92–100%, to diagnose and manage patients resulting in time and cost savings in the range of 24–137 min and $60–67 per patient.
This systematic review and meta-analysis demonstrates the utility of virtual care for preoperative assessment of surgical patients. Virtual preanesthesia evaluation had similar surgery cancellation rates, high patient satisfaction, and reduced costs compared to in-person evaluation.

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^☆: Received from the Medical College of Virginia, Richmond, VA.

^∗: Senior Assistant Resident, Department of Oral and Maxillofacial Surgery.

^†: Associate Professor and Director of Residency Training, Department of Oral and Maxillofacial Surgery.

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Clinical articleTelemedicine consultations in oral and maxillofacial surgery☆

Abstract

Telemedicine in use: The Medical College of Virginia, The Powhatan Correctional Center and The Blackstone Family Practice Center

Virg Med Q

The case of Powhatan Correctional Center/Virginia Department of Corrections and Virginia Commonwealth University/Medical College of Virginia

Telemed J

Clinical article
Telemedicine consultations in oral and maxillofacial surgery☆