SURGICAL WARD ROUND FOR HOSPITAL DISCHARGE AFTER BARIATRIC SURGERY UTILIZING A TELEPRESENCE ROBOT: A RANDOMIZED CONTROLLED NON-INFERIORITY TRIAL COMPARED TO IN-PERSON WARD ROUND.
Guilherme D. Mazzini*2, Leonardo Kristem1, Cacio R. Wietzycoski3
1Biochemstry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; 2Virginia Commonwealth University Health System, Richmond, VA; 3Hospital Unimed Vale do Caí, Montenegro, RS, Brazil
Telemedicine has grown exponentially in health assistance. However, the safety and efficacy of this technology, and specifically the robot assisted telepresence (RAT), is still under scrutiny. We aimed to compare the use of RAT in surgical ward rounds versus traditional in-person rounds, to evaluate and discharge patients admitted after metabolic and bariatric surgery (MBS).
Methods:
We conducted a prospective, open-label, non-inferiority randomized controlled trial to investigate if the use of RAT during ward rounds and hospital discharge is non-inferior to in-person hospital ward round and hospital discharge, in patients admitted after MBS. All patients undergoing MBS were consecutively randomized, at the first postoperative day, and the discharge was planned to occur on the second day. Patients were seen during ward rounds by the multidisciplinary team (nurse, dietitian, physical therapist) physically present. The surgeon was either physically present (in-person) or remotely present via RAT. Telepresence robot used was a PadBot U2 (iPresence ltd., Japan) through a secure wi-fi connection. The primary endpoint was the rate of successful hospital discharges by the randomized method on the second postoperative day. Secondary endpoints included number of visits to the emergency department, hospital readmission, and patients' perceptions evaluated by a validated questionnaire utilizing a Likert' scaled evaluating 4 domains (communication, dignity and confidentiality, content, and timing).
Results:
Ninety-six patients meeting the inclusion criteria, who underwent laparoscopic MBS between February 2020 and May 2022, were randomly assigned to receive their discharge performed by a surgeon on RAT (n = 48) or in-person (n = 48). Table 1 shows clinical and demographic data from the study population. Hospital discharge assisted by a telepresence robot had no inferior rate of success than in-person (100% vs 100%, p < 0.001). There were no differences in number of patients seen in emergency (2.1% vs 2.1% p = 0.99), no readmission or reoperation were observed. The median score of the 4 questionnaires were similar in both groups for all domains evaluated communication [in-person: 5 (5-10) vs. RAT: 5 (5-10), P=0.75]; dignity and confidentiality [in-person: 2 (2-4) vs. RAT: 2 (2-4), P=0.99]; content [in-person: 5 (5-10) vs. RAT: 5 (5-10), P=0.8]; timing [in-person: 1 (1-2) vs. RAT: 1 (1-2), P=0.99].
Conclusions:
The use of RAT in ward rounds to discharge patients after MBS is non-inferior to the in-person visit. Additionally, the patients' perception of communication, dignity and confidentiality, content, and timing was similar between groups. The use of telepresence in ward rounds might help the surgeon in patient management.
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