LAUSR

Dear JOCS Editorial board, Recently, medical students Anish Verma et al. wrote a letter to the editor regarding my recent article, “Telemedicine in the era of coronavirus 19: Implications for postoperative care in cardiac surgery.” While some concerns were raised, areas of consensus were also highlighted. Below, I will directly respond to the concerns raised, summarize areas of consensus, and propose future research directions. The main concern relates to our lack of control group which may introduce lesser quality evidence and sampling bias. Indeed, this is a limitation we highlighted ourselves in the conclusions of our paper. As previously explained, nonurgent inpatient visits at our institution were limited to encourage social distancing and reduce the risk of COVID‐19 exposure for our patients. Thus, due to the ongoing pandemic, it was impossible to introduce a control group of inpatient visits at the time of our study. Another concern highlighted in their letter was the presence of interviewer bias and possible recall bias impacting survey findings and limiting internal validity. In this, we also agree, as these limitations were highlighted in the conclusions of our paper. While it would have been preferable to administer personal copies of the survey to each patient to fill out privately and individually at the time of their appointment, we were unable to do so via email because the demographic of cardiac surgery patients skew to a much older age group without active email addresses to send a personalized survey online. Moreover, because visits were done remotely, there was no way to administer a paper survey in person and ensure a timely response. Given the lack of any published data on the use of telemedicine in this population, we aimed to provide a timely assessment of its efficacy within the boundaries set by the ongoing pandemic and efforts to socially distance. Based on the above, an issue where I hope we can agree is that more investigation is needed to determine the long‐term viability of telemedicine in cardiac surgery patients. Both I and Verma et al. were able to identify multiple studies exploring the use of telemedicine in a number of different surgical subspecialties. However, to my knowledge, my study remains the only investigation into the utility of telemedicine in the cardiac surgery population in the United States. If telemedicine is going to become a viable long‐term option for postoperative care in cardiac surgery patients, more research is required. Future directions include a case‐ control study, as previously suggested by myself and Verma et al., and a comparison of postoperative complication rates at different intervals following surgery in patients who received postoperative care via telemedicine versus those who received in‐person postoperative care. If outcomes are comparable, we can reassure hesitant patients that their care won't be compromised by a shift to telemedicine‐based postoperative care. In conclusion, I am pleased that my review has ignited some healthy academic discourse and hope that researchers interested in the implementation of telemedicine in the cardiac surgery population will benefit from the perspectives presented. To the extent that future research can address the issues discussed here, the scientific quality of research into the utility of telemedicine in the cardiac surgery population as well as its clinical relevance, uptake, and dissemination will continue to improve.