Telemedicine for Delivery of Postoperative Care Following Minimally-Invasive Gynecologic Surgery: A Randomized Controlled Trial

S. Radtke, R. Umeh, M. Chávez, Zuleika V. Curiel, Karla Méndez
In: Journal of Minimally Invasive Gynecology · 2020 · vol. 27(7) , pp. S113 · doi:10.1016/j.jmig.2020.08.179 · W3100893520
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A randomized trial of patients undergoing laparoscopic excision of endometriosis found that telemedicine postoperative care yielded higher patient satisfaction scores than traditional office visits without increasing complication risks.

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This randomized controlled trial evaluated whether telemedicine improves patient satisfaction for postoperative care following minimally invasive gynecologic surgery compared to traditional office visits. The study analyzed data from 41 patients aged 18 to 60 who underwent either laparoscopic hysterectomy or laparoscopic excision of endometriosis, randomizing them to receive follow-up care via video consultation or in-person examination. Results indicated that patients in the telemedicine group reported significantly higher satisfaction scores regarding general satisfaction and time spent with their physician, without any increase in emergency room visits or phone calls to the clinic. This paper is centrally about endometriosis — specifically, it includes patients undergoing laparoscopic excision of endometriosis as part of its surgical cohort to assess postoperative care delivery methods.

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Abstract

Study Objective Determine if patient satisfaction is greater after delivering postoperative care via telemedicine following minimally invasive gynecologic surgery. Design Randomized controlled trial Setting University based outpatient clinic. Patients or Participants Between 18 and 60 years of age scheduled to undergo laparoscopic hysterectomy or laparoscopic excision of endometriosis. Interventions Eligible patients were randomized to receive postoperative care either through a traditional office visit or via telemedicine. Measurements and Main Results 41 patients were analyzed out of which 25 were allocated to the office group and 16 to the telemedicine group. Groups were homogenous to age (41.4 v 43.3 p.48), BMI (31.9 v 30.6 p=.52), distance in miles from home (12.7 v 12.4 p=.92) and parity (p=.51). PSQ-18 questionnaire was scored and each category was compared between the office and telemedicine groups. When comparing medians (IQR), the general satisfaction and time spent with doctor categories were significantly higher in the telemedicine group (4.0 (4.0, 4.5) v 4.5 (4.5, 5.0) p=.05), (4.0(4.0, 4.5) v 4.5(4.0, 5.0) p=.05). The remainder of the categories analyzed were not different between groups (Technical Quality (4.0 (3.8, 4.5) v 4.5 (3.9, 5.0) p=.13), Interpersonal Manner (4.0 (4.0, 4.5) v 4.5 (4.0, 5.0) p=.34), Communication (4.5 (4.0, 4.5) v 4.5 (4.3, 5.0) p=.21) and Accessibility and Convenience (4.0 (3.5, 4.5) v 4.0 (3.6, 4.5) p=.84)). A chart review was performed, examining the first 30 days after surgery. One (4%) patient in the office group visited the ER following the postoperative visit, and 0 in the telemedicine group (p=.42). Regarding phone calls to the clinic after postoperative visit, 5(20%) patients in the office group incurred in at least one call and 4(25%) did so in the telemedicine group (p=.92).

Conclusion

Postoperative care via telemedicine after gynecologic surgery results in higher patient satisfaction, and does not appear to increase the risk of complications.

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