Main Document
As medical students based at The University of Manchester, we welcome
the article “Telemedicine in the era of coronavirus 19:
Implications for postoperative care in cardiac surgery” with great
interest.1 Telemedicine has rapidly expanded to become
an integral component of healthcare delivery during the COVID-19
pandemic, following unprecedented restrictions on social contact. During
our medical education, we have observed the impact of telemedicine
first-hand during clinical practice with respect to maintaining social
distancing measures, maximising resource efficiency and expanding
connectivity. This study is commendable in being the first to evaluate
the use of telemedicine in postoperative care following cardiac surgery,
during an era where simulation-based training is essential for cardiac
surgery trainees.2
The study was appropriately designed through its inclusion of specific
questions, which have been frequently validated in previous studies
evaluating wider implications of telemedicine.3 It
examined a number of relevant issues pertinent to telemedicine,
including perceived utility, patient satisfaction and efficiency.
Furthermore, the combined use of the Likert scale and qualitative
measures allowed for stronger and clearer conclusions to be drawn.
Significantly, the use of a secure platform for recording responses was
an appropriate means of ensuring that patient confidentiality remains
protected. A particular limitation within this study was the absence of
a control group. In accordance with the hierarchy of evidence, results
from a cross-sectional study are generally weaker in quality as compared
to a case-control study. The resulting sampling bias and low response
rate limits the external validity of this study’s findings. Furthermore,
the interviewer bias and possible recall bias presents a challenge to
the internal validity of the study.
Notably, similar findings were found in other studies evaluating the
impact of telemedicine in the context of postoperative care during the
COVID-19 pandemic. This includes those relating to laparoscopic
surgery4 and neurosurgery.5Strikingly, whilst the outcomes of these studies demonstrated the safe,
effective and patient-preferred use of telemedicine, this could not be
applied in the context of cardiac surgery, as per the study by Sallam
et. al. A potential reason for the preference of in-person follow-up may
be due to the multidisciplinary, lengthy and complex nature of
postoperative care programmes after cardiac surgery. Furthermore, the
studies highlighted the well-established barriers associated with
telemedicine, such as technical issues, which may also contribute as a
significant factor.
To conclude, this article highlights that the recent use of telemedicine
in postoperative care following cardiac surgery can result in high
patient satisfaction. However, there remain doubts over its long-term
integration into standard practice for cardiac surgery after the
pandemic, particularly as a significant proportion of patients still
prefer face-to-face consultations for postoperative care. Further
studies are needed to address patient hesitancy surrounding telemedicine
in this field and should account for the aforementioned limitations of
this study. Regardless, telemedicine retains the potential to be a
significant aspect of future postoperative care following cardiac
surgery. If so, we maintain that it is imperative that the curriculum at
medical school is adjusted accordingly to prepare cardiac surgery
trainees for this.