The rapid transformation of the health care delivery system and surgical services across the US as a result of the COVID-19 pandemic was unprecedented. To limit COVID-19 exposure and transmission between patients and clinicians, millions of elective surgical procedures were suspended and necessity compelled surgeons to adopt telemedicine for preoperative, follow-up, and emergent surgical care visits. By summer 2020, surgical care gradually started returning to business as usual, but with the resurgence of COVID-19 cases in the fall and winter, suspension of elective surgery was reinstated in some states with surgical outpatient care continuing to be delivered by telemedicine.

Substantive changes in regulations permitting telemedicine clearly facilitated the dramatic shift to telemedicine during the pandemic. Arguably, the most important of these regulations is that of the US Centers for Medicare & Medicaid Services (1135 Waivers) making reimbursement of in-person and telemedicine visits equal in March 2020.¹ Other third-party payers quickly followed. As a result, hospitals and surgical departments repositioned available technology to initiate widespread delivery of care by telemedicine. These institutions used primarily synchronous (eg, videoconference telemedicine visits) and asynchronous (eg, text messages, email, patient portal) telemedicine modalities.² The third modality, remote patient monitoring, which uses technology such as wearable devices to monitor patients outside conventional clinical settings, was least used.

Approval of several effective COVID-19 vaccines and initiation of vaccination programs should, in time, mitigate the need to reduce in-person health care visits. While some proclaim that the pandemic finally surmounted long-standing resistance to the adoption and integration of major digital and technological advances into health care delivery,¹ recent national data suggest that the matter may be more nuanced. In a Commonwealth report, Mehrotra and colleagues³ analyzed 50 million outpatient visits (up to October 1, 2020) and found a rebound of in-person, outpatient visits to pre–COVID-19 levels with a concomitant decline in telemedicine visits. In fact, in-person surgical visits were higher compared with the prepandemic period with telemedicine visits only accounting for 2% to 3% of all visits. This resurgence of in-person surgical care may signal that telemedicine may not be a satisfactory or sufficient replacement. While the COVID-19 pandemic highlighted the feasibility of using telemedicine to deliver some aspects of surgical care, the Commonwealth report³ suggests that it may be viewed, by both patients and clinicians, as a temporary adaptation rather than a permanent substitute for in-person visits, even with expanded reimbursement.

由于 COVID-19 大流行，美国医疗保健提供系统和外科服务的快速转型是前所未有的。为了限制 COVID-19 在患者和临床医生之间的接触和传播，数以百万计的选择性外科手术被暂停，并且有必要迫使外科医生在术前、随访和紧急外科护理访问中采用远程医疗。到 2020 年夏季，外科护理逐渐开始恢复正常，但随着秋季和冬季 COVID-19 病例的死灰复燃，一些州恢复了暂停择期手术，外科门诊继续通过远程医疗提供。

允许远程医疗的法规的实质性变化显然促进了大流行期间向远程医疗的巨大转变。可以说，这些法规中最重要的是美国医疗保险和医疗补助服务中心（1135 豁免）在 2020 年 3 月对面对面和远程医疗就诊的报销相同^。1其他第三方付款人迅速跟进。结果，医院和外科部门重新定位了可用技术，以通过远程医疗开始广泛提供护理。这些机构主要使用同步（例如，视频会议远程医疗访问）和异步（例如，文本消息、电子邮件、患者门户）远程医疗方式。² 第三种模式是远程患者监测，它使用可穿戴设备等技术在常规临床环境之外监测患者，使用最少。

批准几种有效的 COVID-19 疫苗并启动疫苗接种计划应及时减轻减少亲自就诊的需要。虽然一些人宣称，这种流行病最终克服了长期以来对采用重大数字和技术进步并将其整合到医疗保健服务中的阻力，但最近的国家数据¹表明，这件事可能更加微妙。在联邦报告中，Mehrotra 及其同事³分析了 5000 万次门诊就诊（截至 2020 年 10 月 1 日），发现亲自门诊就诊次数反弹至 COVID-19 之前的水平，同时远程医疗就诊次数下降。事实上，与大流行前时期相比，面对面的手术就诊次数更高，远程医疗就诊仅占所有就诊次数的 2% 至 3%。现场手术护理的复苏可能表明远程医疗可能不是令人满意或充分的替代品。尽管 COVID-19 大流行强调了使用远程医疗提供外科护理某些方面的可行性，但英联邦报告³表明，患者和临床医生都可能将其视为临时适应，而不是永久替代面对面访问，即使扩大报销。