Total Telemedicine Pathway for Inflammatory Bowel Disease Surgical Care Expands Access to an Academic Inflammatory Bowel Disease Center

Background:
Telemedicine care for inflammatory bowel disease (IBD) has evolved and its use has rapidly accelerated due to the COVID-19 pandemic. Studies have shown that remote care in IBD patients is similar to usual care, with no association with increase in IBD-related hospitalization, and with high levels of satisfaction in care. However, telemedicine for surgical care and perioperative anesthesia evaluation in IBD patients remains to be further elucidated in the literature. We report on the impact of a novel total telemedicine pathway (TTP) for IBD patients requiring surgical intervention. The aim of this study is to describe the outcomes of this program as well as the impact it has on distance and driving time saved.
Methods:
The TTP pilot program began on February 2023, and the 13 IBD patients included in this study underwent surgery between March 2023 and November 2023. All patients were consented to be included in the UPMC IBD registry and have their clinical information extracted. Patients received a virtual surgical consultation as well as virtual anesthesia pre-operative electronic consultation prior to their operation. Google Maps was utilized to calculate distances (miles) from the patient’s home address to the main academic medical center, where the IBD, surgical, and perioperative clinics are located. Driving times were standardized to departing from their home address on a weekday at 8 AM to travel to the academic medical center, in order to obtain round trip distance and driving time saved.
Results:
Of the 13 patients included, 10 were female and 3 were male; 12 patients had Crohn’s disease, and 1 had ulcerative colitis. The procedures performed were ileocolonic resection (n=9), total abdominal colectomy (n=2), and proctectomy (n=2). The mean patient age was 41. No major surgical adverse events occurred, and median follow-up time after the surgery was 13 months. On average, patients had 1.23 preoperative visits with surgery, 1 visit with perioperative anesthesia and 1.36 postoperative visits with surgery throughout the observed period. 2 patients had at least 1 additional in person visit with surgery postoperatively. Moreover, 10 of the 13 patients had at least 1 IBD telemedicine visit within 6 months prior to surgery and 9 of the 13 patients were seen via IBD telemedicine at least once within 6 months post-surgery. The average patient travel distance (round trip) was 101 miles, with a median distance of 46 miles. Average drive time (round trip) was 118 minutes, with a median driving time of 68 minutes. A total of 6,195 miles and nearly 116 hours in driving time were saved just for these 13 patients.
Conclusions:
TTP for IBD surgical patients, particularly when coupled with existing IBD virtual care, can expand access to multi-disciplinary IBD expertise, while increasing convenience and with positive environmental impact by saving driving miles. This virtual care impact might be particularly pronounced for patients that live at greater distances from the IBD center in more rural communities, whom otherwise would not have access to IBD-focused medical or surgical care, and future efforts should focus on targeting these patients.