The Efficacy of Telemedicine Versus In-Person Education for High-Risk Patients Undergoing Primary Total Joint Arthroplasty

Samantha N Baxter; Andrea H Johnson; Jane C Brennan; Steffanie S Dolle; Justin J Turcotte; Paul J King

doi:10.1016/j.arth.2023.01.015

The Efficacy of Telemedicine Versus In-Person Education for High-Risk Patients Undergoing Primary Total Joint Arthroplasty

J Arthroplasty. 2023 Jul;38(7):1230-1237.e1. doi: 10.1016/j.arth.2023.01.015. Epub 2023 Jan 20.

Authors

Samantha N Baxter¹, Andrea H Johnson², Jane C Brennan³, Steffanie S Dolle³, Justin J Turcotte⁴, Paul J King³

Affiliations

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.

PMID: 36690187
DOI: 10.1016/j.arth.2023.01.015

Abstract

Background: While 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.

Methods: A 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.

Results: When 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).

Conclusion: This 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.

Keywords: hip arthroplasty; knee arthroplasty; length of stay; racial disparities; readmission; telemedicine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Arthroplasty, Replacement, Hip* / adverse effects
Arthroplasty, Replacement, Knee* / adverse effects
Humans
Length of Stay
Patient Discharge
Patient Readmission
Postoperative Complications / etiology
Retrospective Studies
Risk Factors