Telemedicine use by medicare beneficiaries undergoing hepatopancreatic surgery during COVID-19

Background: The COVID-19 pandemic has played a substantial role in exacerbating pre-existing disparities access to surgical care. In particular, vulnerable communities have not been able avail the benefits of telemedicine facilities under Medicare coverage waiver. We sought explore trends and predictive factors associated with use. Methods: Patients who underwent hepatopancreatic (HP) surgery between 2013-2020 were identified from Standard Analytic Files (SAF). utilization was quantified after implementation waiver, data on county-level social vulnerability index (SVI) procured Centers for Disease Control/Agency Toxic Substances Registry. Interrupted time series analysis multivariable logistic regression used assess association SVI Results: After total 3,031 patients hepatic (n=1,199, 39.6%), pancreatic (n=1,378, 45.5%) or both surgeries (n=454, 15.0%). median age 70 (IQR 66-74), majority being female (n=1,599, 52.8%), White (n=2,641, 87.1%), having high comorbidity burden [Charlson Comorbidity Index (CCI) >2; n=1,544, 51.3%]. Most resided counties characterized by intermediate [SVI, low: 10.62% (n=322); moderate: 63.84% (n=1,935); high: 25.54% (n=774)]. 45.8% (n=1,388) participated at least one outpatient visit. Telemedicine use post-waiver period peaked May 2020 varied relative (Low SVI: n=150, 46.58% vs. moderate n=937, 48.42% vs n=301, 38.89%, p2 (referent ≤2; OR 1.49, 95% CI 1.28-1.71) more likely (all p< 0.001). Conclusion: These results indicate that lived highly elderly less like facilities, while Black those utilize telemedicine. With an ever-increasing dependence healthcare technology, policies ensure equitable digital resources are required.