(I-510) Accuracy of Surgical Plans Made via Telemedicine Versus In-Person Encounters for Elective Spine Surgery: A Comparative Retrospective-Prospective Cohort Study

Introduction: The COVID-19 pandemic facilitated the rapid adoption of telemedicine. Because operative plans for spinal pathology may depend on physical examination, the lack of in-person evaluation has led to concerns about diagnostic accuracy. We sought to demonstrate that there was no significant difference in diagnostic accuracy for surgical plans created via telemedicine versus in-person visits for patients undergoing elective spine surgery.

Methods: We prospectively collected data on consecutive patients who scheduled elective surgery via in-person visits from 9/1/2021-12/31/2021 and retrospectively for telemedicine visits from 5/15/2020-12/31/2020. We excluded surgeries for thoracolumbar deformity, with 6 or more operative levels, kyphoplasty/vertebroplasty, sacroiliac joint fusion, and pain pump/stimulator placement. Surgical plans made during telemedicine or in-person clinic encounters were compared to the operations performed. The primary outcome was surgical plan change (number of operative levels, +/- fusion, +/- decompression, approach). Secondary outcomes were reasons for change and time of operative plan change. Comparability between groups was evaluated for confounders, including demographics, socioeconomics, and operative data. Univariate analyses and a backward stepwise logistic regression were performed. P<.05 was considered significant.

Results: We included 610 surgeries (308 telemedicine, 302 in-person). Compared to in-person patients, telemedicine patients were significantly younger (58.34±13.62 versus 60.58±13.32, p=.041) with higher body mass index (31.35±6.53 versus 30.09±6.17, p=.015), were more likely to be a return patient (p <.001) with a greater number of visits (2.46±1.46 versus 1.91±1.16, p<.001). The telemedicine patients had a significantly shorter visit to surgery interval (0.67 versus 0.88 months, p=.007). There was no significant difference in the proportion of changed surgeries between cohorts (3.9% versus 4.0%, p=.96). The most common change in surgical plan was a change in operative level numbers, with the most common reason being imaging findings. Encounter to surgery interval (OR 1.72, 95%CI 1.28-2.31, p<.001) and number of operative levels (OR 1.84, 95%CI 1.33-2.54, p<.001) were independently associated with a change in operative plan. Telemedicine was not independently associated with increased odds of surgical plan change.

Conclusion : Surgical plans formulated via telemedicine encounters have similar accuracy to those made via in-person encounters.

How to Improve Patient Care: