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Telemedicine for Follow-up Management of Patients After Liver Transplantation: Cohort Study

机译：肝移植后患者随访的远程医疗：队列研究

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Background Technical capabilities for performing liver transplantation have developed rapidly; however, the lack of available livers has prompted the utilization of edge donor grafts, including those donated after circulatory death, older donors, and hepatic steatosis, thereby rendering it difficult to define optimal clinical outcomes. Objective We aimed to investigate the efficacy of telemedicine for follow-up management after liver transplantation. Methods To determine the efficacy of telemedicine for follow-up after liver transplantation, we performed a clinical observation cohort study to evaluate the rate of recovery, readmission rate within 30 days after discharge, mortality, and morbidity. Patients (n=110) who underwent liver transplantation (with livers from organ donation after citizen's death) were randomly assigned to receive either telemedicine-based follow-up management for 2 weeks in addition to the usual care or usual care follow-up only. Patients in the telemedicine group were given a robot free-of-charge for 2 weeks of follow-up. Using the robot, patients interacted daily, for approximately 20 minutes, with transplant specialists who assessed respiratory rate, electrocardiogram, blood pressure, oxygen saturation, and blood glucose level; asked patients about immunosuppressant medication use, diet, sleep, gastrointestinal function, exercise, and T-tube drainage; and recommended rehabilitation exercises. Results No differences were detected between patients in the telemedicine group (n=52) and those in the usual care group (n=50) regarding age ( P =.17), the model for end-stage liver disease score (MELD, P =.14), operation time ( P =.51), blood loss ( P =.07), and transfusion volume ( P =.13). The length and expenses of the initial hospitalization ( P =.03 and P =.049) were lower in the telemedicine group than they were in the usual care follow-up group. The number of patients with MELD score ≥30 before liver transplantation was greater in the usual care follow-up group than that in the telemedicine group. Furthermore, the readmission rate within 30 days after discharge was markedly lower in the telemedicine group than in the usual care follow-up group ( P =.02). The postoperative survival rates at 12 months in the telemedicine group and the usual care follow-up group were 94.2% and 90.0% ( P =.65), respectively. Warning signs of complications were detected early and treated in time in the telemedicine group. Furthermore, no significant difference was detected in the long-term visit cumulative survival rate between the two groups ( P =.50). Conclusions Rapid recovery and markedly lower readmission rates within 30 days after discharge were evident for telemedicine follow-up management of patients post–liver transplantation, which might be due to high-efficiency in perioperative and follow-up management. Moreover, telemedicine follow-up management promotes the self-management and medication adherence, which improves patients’ health-related quality of life and facilitates achieving optimal clinical outcomes in post–liver transplantation.
机译：背景技术表演肝移植的技术能力迅速发展;然而，缺乏可用的肝脏已经促使边缘供体移植物的利用，包括循环死亡，较旧的供体和肝脏脂肪变性后捐赠的人，从而使得难以定义最佳的临床结果。目的我们旨在探讨肝移植后远程医疗治疗后续管理的疗效。方法以确定远程尿液后续肝移植后的疗效，我们进行了临床观察队列研究，评估了放电，死亡率和发病率后30天内的回收率，再入院率。随机分配肝移植的患者（N = 110）患者（公民死亡后的器官捐赠的肝脏），除了通常的护理或通常的护理外部外，还会收到两周的远程医疗的后续管理。远程医疗组中的患者免费获得2周后2周的机器人。使用机器人，患者每天互动，约20分钟，随着移植专家评估呼吸速率，心电图，血压，氧气饱和度和血糖水平;询问患者有关免疫抑制药物用药，饮食，睡眠，胃肠功能，运动和T型管排水;并推荐康复练习。结果在远程医疗组（N = 52）中患者之间没有检测到差异，通常护理组（N = 50）关于年龄（p = .17），末期肝病评分模型（MELD，P = .14），操作时间（p = .51），失血（p = .07）和输血量（p = .13）。初始住院治疗的长度和费用（p = .03和p = .049）在远程医疗组中较低，而不是通常的护理后续组。在肝脏移植前患者患者≥30的患者数量在通常的护理后续组比远程医疗组织中更大。此外，在远程医疗组中放电30天内的再入院率比通常的护理后续组（P = .02）在遥远访组中显着降低。远程医疗组12个月的术后存活率分别为94.2％和90.0％（p = .65）。警告在远程医疗组早期检测到并发症的迹象。此外，在两组之间的长期访问累积存活率（P = .50）中没有检测到显着差异。结论在肝脏移植后患者的远程医疗后续管理后30天内快速恢复和显着降低入院率，这可能是由于围手术期和后续管理的高效率。此外，远程医疗后续管理促进了自我管理和药物依从性，从而提高了患者的健康状生活质量，并促进肝后移植术后最佳的临床结果。

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