INTRODUCTION: Telemedicine provides patients with a convenient method of communication with providers. However, little is known about accessibility of telemedicine among surgical patients. We aimed to assess the association of telemedicine use with patient no-show visits. METHODS: Clinic data from 7 surgical clinics at an academic medical center were reviewed (January 2018 to December 2021). A historical control (January 2018 to March 2020, in-person visits), contemporary control (March 2020 to December 2021, in-person visits), and case cohort (March 2020 to December 2021, telemedicine visits) were compared for no-show visits using ANOVA and multivariable logistic regression. RESULTS: There were 553,475 visits, of which 11.3% were no-show. Most visits were in the historical control (54.1%) compared with contemporary control (41.5%) and case visits (4.4%). No-show visits were most frequent among in-person (11.7%) compared with telemedicine visits (2.5%, p < 0.001). On logistic regression, no-show visits were more common among male (adjusted odds ratio [aOR] 1.12, 95% CI 1.09 to 1.15) patients, Black (aOR 1.68, 95% CI 1.64 to 1.73) and Asian (aOR 1.32, 95% CI 1.21 to 1.44, ref: White) patients, patients insured with Medicaid (OR 2.0, 95% CI 1.94 to 2.06, ref: Private), patients from counties with higher Social Vulnerability Index (OR 1.13, 95% CI 1.06 to 1.21), and Friday visits (OR 1.15, 95% CI 1.1 to 1.2, ref: Monday). No-show visits were less common among older patients (OR 0.98, 95% CI 0.98 to 0.98), those insured with Medicare (OR 0.83, 95% CI 0.76 to 0.91), and telemedicine visits (OR 0.21, 95% CI 0.19 to 0.24) and contemporary control (OR 0.93, 95% CI 0.91 to 0.95, ref: retrospective control) cohorts (Figure).FigureCONCLUSION: Telemedicine is associated with 79% reduction in odds of no-show visits, which are more frequent among historically vulnerable populations. Telemedicine's convenience may serve as an intervention to improve health equity and access.

INTRODUCTION: Telemedicine is designed to increase healthcare access. However, its effect on surgical outcomes is not yet known. We aimed to characterize perioperative telemedicine use and determine whether it was associated with postoperative complication. METHODS: Surgical appointments at a tertiary care academic center in Alabama were reviewed from March 1, 2020, to October 4, 2021 (n = 3,207 visits, 1,759 patients). Visits closest to and within 60 days of operation were cross-referenced with institutional American College of Surgeons NSQIP data. t-tests and logistic regression were performed to characterize perioperative telemedicine use and determine associations with postoperative surgical site infection (SSI) and 30-day readmission. RESULTS: Data was available for 1,953 preoperative and 2,054 postoperative visits. Telemedicine was used similarly preoperatively (16.5%) and postoperatively (16.9%, p = 0.8). Telemedicine preoperative visits were closer to operation than in-person (22.2 vs 23.7 days, p = 0.003). Telemedicine postoperative visits were further from operation (27.9 vs 23.7 days, p < 0.001). Preoperative telemedicine visits were more often with general surgery (ref: orthopedic, adjusted odds ratio [aOR]: 4.47, 95% CI: 3.05 to 6.55), for outpatient operation (aOR: 1.84, 95% CI: 1.39 to 2.42), and for lower American Society of Anesthesiologists score patients (aOR: 0.71, 95% CI: 0.54 to 0.94). There was no significant association between telemedicine use and age, race, or BMI. Similar findings existed for postoperative visits. SSI was lower among operations with telemedicine preoperatively (aOR: 0.46, 95% CI: 0.21 to 0.99) and postoperatively (aOR: 0.37, 95% CI: 0.17 to 0.8) without significant association with 30-day readmission. CONCLUSION: Most perioperative appointments are currently in-person, with telemedicine use typically occurring for healthier patients undergoing outpatient operation. Perioperative telemedicine use is not associated with increased SSI or readmission and should be considered as an option to improve surgical access while maintaining quality care.