Authors: Jenny Zhang 1, Kristina Dushaj 1, Vijay J Rasquinha 2, Giles R Scuderi 1, Matthew S Hepinstall 1
1Department of Orthopedics, Lenox Hill Hospital, New York, NY.
2Department of Orthopedics, Long Island Jewish Medical Center, New Hyde Park, NY.
Abstract
Background
Prompt identification and treatment of wound complications is essential after joint arthroplasty, but emergency department and office visits for urgent evaluation of normal incisions are a source of unnecessary cost. The purpose of this study is to evaluate the use of an online image messaging platform for remote monitoring of surgical incision sites.
Methods
We conducted a retrospective review of 1434 hip and knee arthroplasty patients who registered for an online platform in the perioperative period. We reviewed images sent by patients to evaluate potential wound abnormalities. Medical records were reviewed to determine whether assessments based on wound photographs corresponded with subsequent in-person findings and ultimate disposition.
Results
Four hundred thirty patients (42%) sent at least one text or image message to their provider. Elimination of redundant images resulted in 104 image encounters, with 76 discrete encounters in 41 patients related to the surgical wound. Most showed normal wound appearance; patients were reassured and urgent visits were avoided. At scheduled in-person follow-up, none of these patients demonstrated unrecognized wound complications. Seventeen image encounters in 7 patients showed possible wound abnormalities. These prompted in-person follow-up on average less than 1 day later for 4 issues deemed urgent (2 patients received surgical treatment) and 5 days later for issues deemed nonurgent. Photos were also used to monitor abnormal wounds over time and to send information unrelated to wounds.
Conclusion
Utilization of an online physician-patient messaging platform can prevent unnecessary visits for normal appearing wounds, while facilitating rapid in-person treatment of wound complications.