Abstract
BACKGROUND: The increasing prevalence of ambulatory surgeries has highlighted the need for effective postoperative follow-up. While telemedicine represents a promising option for perioperative support and postoperative monitoring, evidence of its actual benefits remains limited. OBJECTIVE: This study aims to evaluate the medico-economic impact of a personalized telemedicine platform for postoperative follow-up in day-surgery patients in terms of cost-effectiveness and cost-utility. METHODS: This single-blinded, 2-group randomized controlled trial was conducted at the Centre Hospitalier de l'Université de Montréal (CHUM) from August 2022 to September 2023. Adults undergoing elective day surgery were randomized into 2 groups: the intervention group, which received postoperative follow-up via the LeoMed telemedicine platform, and the control group, which received standard care. The intervention group used a personalized telehealth platform offering preoperative education, psychological support, and postoperative monitoring through daily follow-up forms sent to patients' smartphones. Alerts generated by patient responses were reviewed by CHUM's telehealth support unit. The primary outcome was unanticipated health care usage, including emergency visits, readmissions, and medical consultations within 30 days postprocedure. Secondary outcomes included gained quality-adjusted life years (QALYs), patient satisfaction, health care costs, and greenhouse gas emissions. Demographic and outcome data were summarized using descriptive statistics; categorical variables were reported as frequencies and percentages, and continuous variables as means with standard deviations. Between-group comparisons were conducted using appropriate statistical tests by the HEC Montréal health economics team, following an intention-to-treat approach. RESULTS: Of 1411 patients screened, 1214 were randomized, with 436 in the intervention group and 445 in the control group analyzed. Compliance with the platform was high, with a mean compliance index of 0.89 in the intervention group. No significant differences in unanticipated health care usage were observed. The average cost of unplanned care was CAD $370 (US $275) in the control group versus CAD $323 (US $239) in the intervention group (P=.60). The intervention group demonstrated a statistically significant QALY gain at postoperative day 14 (0.002; P=.01), but the difference was no longer significant at day 30 (0.001; P=0.14). There were also no significant differences in GHG emissions between the groups, with the intervention group emitting an average of 0.870 kg CO₂-eq compared with 1.055 kg CO₂-eq in the control group (P=.52). However, patient satisfaction was significantly higher in the intervention group at both days 14 (P=.02) and 30 (P<.001). CONCLUSIONS: This trial demonstrates the potential of telemedicine platforms to enhance postoperative care in ambulatory surgery settings. While no significant reductions in health care usage were observed, the intervention improved QALYs and patient satisfaction, suggesting potential cost-utility benefits. Larger trials are needed to confirm these findings and explore the impact on long-term recovery and health care savings.