Impact of Telemedicine and COVID Pandemic on Utilization of Advanced Pediatric Surgical Services

Purpose : The COVID-19 pandemic disrupted health care worldwide. We evaluated telemedicine utilization in a pediatric surgery ambulatory setting before and during the pandemic to assess its impact on surgical access. Methods : We conducted a retrospective single-center cohort study of pediatric surgery ambulatory visits from 2019 to 2021. Visit modality, type, and complexity were collected. Socioeconomic and geographic variables included Community Needs Index (CNI) and United States Department of Agriculture rural–urban continuum codes. Chi-square, t tests, and multivariable logistic regression were performed. Results : Among 4,106 visits, monthly volume declined during the pandemic (median 192 vs. 151, p = 0.03), with fewer new patients (26% vs. 30%, p = 0.04). Telemedicine increased (46% vs. 3.6%, p < 0.001), with higher adoption among rural patients (61% vs. 43%, p < 0.001). The proportion of complex visits increased (high complexity: 13–35%, p < 0.001; highest complexity: 1–9%, p < 0.001). In multivariable analysis, utilization increased with rural residence (odds ratios [OR] 1.80, 95% confidence intervals [CI] 1.44–2.25). Utilization was lower among higher-income households (OR 0.90, 95% CI 0.86–0.94) and higher-deprivation communities (CNI OR 0.71, 95% CI 0.61–0.83; all p < 0.001). Conclusions : Telemedicine preserved access to pediatric surgical care during the pandemic, with increased use among rural patients. Lower utilization among both higher-income and higher-deprivation groups highlights complex inequities in access.