A systematic review of telehealth and remote monitoring in vascular surgery

Objective

This systematic review aims to describe the benefits and obstacles of the current and future uses of telehealth and remote monitoring in the field of vascular surgery. Telehealth refers to connecting patients and providers in different locations, whereas remote monitoring refers to telehealth in addition to the use of patient sensors to collect health data.

Methods

Articles indexed in PubMed, Google Scholar, and Scopus were eligible for review. The specific search keywords were “remote monitoring” and “vascular surgery” with articles published from January 1, 2000, to December 31, 2022, considered eligible for inclusion. We identified 906 unique studies initially and, after applying inclusion and exclusion criteria, 22 studies were eligible for inclusion. The PRISMA criteria were followed to structure this review.

Results

During the coronavirus disease 2019 pandemic, the adoption of telehealth and remote monitoring, particularly in vascular surgery, has increased significantly, driven by the need for quarantine and social distancing. The review includes 23 papers and 9717 patients. The greatest number of papers discussed general vascular surgery (n = 12 [52.2%]), followed by wound care (n = 9 [39.1%]) and carotid endarterectomy (n = 3 [13.0%]). The number of articles increased significantly by year (P = .0017). Many patients rated telehealth favorably, with 80.6% reporting their interaction as very good and 66.8% of patients rating telehealth as more convenient. The use of telehealth provided cost savings of $1,065,684 over 5 years and allowed the identification of an additional 31.1% of patients with hypoxemia in the postoperative period. Evidence for use of telehealth in the treatment of diabetic foot ulcers is equivocal, with one study finding increased mortality for diabetic foot ulcer patients in the telehealth group (hazard ratio, 8.68; 95% confidence interval, 6.93-10.88; P = .0001), but another showing decreased mortality in the telehealth group by 21%. Remote monitoring for carotid endarterectomy was shown to be feasible with patients reporting reduced anxiety.

Conclusions

Remote monitoring in vascular surgery has gained support and encouragement in the available literature. In addition to improving patient outcomes and satisfaction, remote monitoring is more affordable to patients and hospitals while improving access between doctors and patients. However, limitations of remote monitoring persist, including difficulties for elderly patients, the need for specific training, and differences in race and socioeconomic status causing disparities in access.