Utilizing telemedicine for delivery of postoperative care following minimally invasive gynecologic surgery: A randomized controlled trial

Abstract

Objectives: Determine if patient satisfaction is greater after delivering postoperative care via telemedicine following minimally invasive gynecologic surgery. Materials and Methods: University-based outpatient clinic; Randomized controlled trial (Canadian Task Force classification I). Females between 18 and 60 years of age scheduled to undergo laparoscopic hysterectomy or laparoscopic excision of endometriosis were invited to participate. Eligible patients were randomized to receive postoperative care either through a traditional office visit or via telemedicine. PSQ-18 satisfaction surveys were performed by phone after the visit. Results: Forty-one patients were analyzed out of which 25 were in the office group and 16 in the telemedicine group. Groups were homogenous to age (41.4 vs. 43.3 p. 48), body mass index (31.9 vs. 30.6 P = 0.52), distance in miles from home (12.7 vs. 12.4 P = 0.92), and parity ( P = 0.51). PSQ-18 questionnaire was scored and each category was compared between the office and telemedicine groups. When comparing medians (interquartile range), the general satisfaction and time spent with doctor categories were significantly higher in the telemedicine group (4.0 [4.0, 4.5] vs. 4.5 [4.5, 5.0] P = 0.05), (4.0 [4.0, 4.5] vs. 4.5 [4.0, 5.0] P = 0.05). The remainder of the categories analyzed were not different between groups Technical Quality (4.0 [3.8, 4.5] vs. 4.5 [3.9, 5.0] P = 0.13), Interpersonal Manner (4.0 [4.0, 4.5] vs. 4.5 [4.0, 5.0] P = 0.34), Communication (4.5 [4.0, 4.5] vs. 4.5 [4.3, 5.0] P = 0.21), Accessibility and Convenience (4.0 [3.5, 4.5] v 4.0 [3.6, 4.5] P = 0.84). A chart review was performed, examining the first 30 days after surgery. One (4%) patient in the office group went to the ER after postoperative visit, and 0 in the telemedicine group ( P = 0.42). Conclusion: Postoperative care via telemedicine after gynecologic surgery results in higher patient satisfaction.

The Use of Digital Health Services Among Patients and Citizens Living at Home: Scoping Review

“…In addition to the concept of video visits and videoconferencing, expressions such as video consultation and video encounter were used when patients had consultations with health care professionals via a video connection. In addition, telehealth visits [ 72 , 119 ], platforms [ 73 ], eHealth [ 117 ], telephone (or voice) calls [ 45 , 52 , 53 , 63 , 65 , 68 , 73 - 78 , 92 - 98 , 100 , 101 , 118 , 127 , 128 ], text messages [ 90 ], and mobile apps [ 118 ] were mentioned as means for consultation. Looi et al [ 93 , 94 ] found that during the second and third quarters of 2021, the telephone was mostly used for telehealth visits in private psychiatry practice in Australia.…”

“…The use of or the possibility for video consultation is especially important for rural and other areas with long distances, though infrastructural or cultural issues may currently prevent or delay the use of digital services in some locations [ 67 , 84 , 108 , 119 ]. According to the results, telephone calls were still used frequently for contacting patients [ 45 , 52 , 53 , 63 , 65 , 68 , 73 , 74 , 92 - 97 , 127 , 128 ]. In some studies, most consultations were done over the phone [ 74 , 93 , 94 , 128 ].…”

Exploring Patient Perspectives Surrounding Telemedicine Versus In-Person Preoperative Visits

“…Several studies examine the use of telemedicine in preoperative visits, 3,5,6 and existing data suggest that telemedicine may be superior to in-person visits for satisfaction in minimally invasive gynecology postoperative appointments. 7 However, there is a paucity of information surrounding patient decision making in choosing telemedicine versus in-person visits for the preoperative appointment in gynecologic surgery. This study adds to the literature by exploring patient perspectives and attitudes toward this decision-making process and offers patient perspectives on the advantages and disadvantages of both approaches.…”

Perioperative visits in minimally invasive gynecologic surgery

“…The primary components of postoperative visits include inquiring about any symptoms or complications in recovery; discussing findings and procedures and pathology results; visually examining the surgical incision; and counseling about long-term postoperative recovery [14 ▪ ]. Office postoperative visits have been shown to incur significant costs for patients, including travel and childcare costs and lost wages [15].…”

“…Although the study was not powered to assess broad feasibility or safety, only two patients required an in-person visit for complications. A 2021 RCT of telemedicine visits compared with in-office visits after laparoscopic hysterectomy or laparoscopic excision of endometriosis showed higher general satisfaction and greater sense of time spent with the doctor compared with office visits [14 ▪ ]. A 2021 noninferiority RCT of telemedicine visits compared with in-office visits after reconstructive surgery for pelvic organ prolapse showed high levels of patient satisfaction and no difference in complications or unscheduled telephone calls or office visits [24].…”