Telemedicine in Surgical Care During COVID-19 in LMICs: A Structured Review of Implementation and Impact

Background

The COVID-19 pandemic severely disrupted surgical care worldwide, with particularly acute effects in low- and middle-income countries (LMICs). Telemedicine (TM) was rapidly adopted to mitigate these disruptions, but evidence on its role in surgical care in LMIC settings remains limited.

Objective

To review the implementation, impact, and challenges of telemedicine in surgical care across LMICs during the COVID-19 pandemic.

Methods

Following PRISMA 2020 guidelines, we searched PubMed, Embase, Web of Science, and Ovid for peer-reviewed studies from December 2019 to July 2022. Studies assessing TM interventions in any surgical specialty within LMICs were included. Data extraction focused on TM platform types, patient and provider outcomes, feasibility, and policy implications. Quality was appraised using the Joanna Briggs Institute tool for observational studies.

Results

Thirteen studies across six surgical specialties and 4,155 patients were included. TM was used for follow-up (46%), consultation (38%), and remote treatment (23%), with high patient satisfaction (mean ≥ 85%), improved access, and cost savings reported. Four studies noted positive clinical outcomes (e.g., reduced complications, optimized medication). Barriers included connectivity issues, regulatory gaps, lack of physical examination capability, and infrastructure inequities.

Conclusions

TM provided feasible, safe, and effective surgical support during the pandemic in LMICs, particularly in rural settings. However, long-term sustainability requires investment in digital infrastructure, standardized protocols, and data privacy regulation. TM should be integrated into national surgical planning beyond COVID-19.

Taxonomy in Telemedicine

Several terms have been used to indicate remote health services, therefore it is essential to differentiate them, understand their scope and their relation to each other [1].

• E-health: The term includes all types of secure use of information and communication technology (ICT) related to health, for example, applications and websites for health promotion, education, screening, research, assessment, and virtual video-chat sessions [2].

• Telehealth: Compared to e-health, telehealth is limited to healthcare over a distance. It is more extensive than telemedicine and incorporates educational activities related to patients and providers, public health intervention, and health administration [3].

• Telemedicine (TM): A subgroup of telehealth that focuses only on the curative aspect. It can be divided into medical specialties such as dermatology (tele-dermatology), psychiatry (telepsychiatry), and radiology (teleradiology).

• Telecare: A subgroup of telehealth that focuses on the preventive aspect. It provides automated monitoring of behavior changes over time.

• mHealth: Mobile technologies that can have a spectrum of purposes in the delivery of care.

the scope and relationship between the different telehealth related terms.