Reasons and Risk Factors for Seeking Unscheduled Medical Advice in the Postoperative Period Among Gynecologic Patients

Chelsea N. Fortin, Emily Holthaus, Milena Radeva, Matthew D. Barber
In: Journal of Gynecologic Surgery · 2018 · vol. 34(6) , pp. 279–284 · doi:10.1089/gyn.2018.0013 · W2809486802
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Abstract

Objective: The aims of this research were to characterize unscheduled postoperative contacts made by gynecologic surgical patients and to identify factors that predispose patients to contact their providers postoperatively. Materials and Methods: This was a retrospective chart review. A convenience sample of all patients undergoing gynecologic surgery at the Cleveland Clinic in Cleveland, OH, over 3 months was utilized. Patients were identified by reviewing the electronic medical records (EMRs). Patient charts were reviewed for potentially relevant demographic and clinical information, as well as any patient-initiated telephone or clinic encounters occurring within 30 days of hospital discharge. Patients with at least one encounter (“Contact” group) were compared to those with no encounters (“No Contact” group). Results: Of the 547 patients undergoing surgery during this time frame, 331 (60%) contacted their providers at unscheduled times postoperatively, resulting in a total of 797 postoperative contact encounters. Patients most commonly contacted their providers regarding new (316 encounters; 50%) or existing (104 encounters; 17%) symptoms. Pain (29% [n = 123]) and wound issues (19% [n = 81]) were the most commonly reported symptoms. The outcome of these encounters was most often reassurance (37% [n = 232]), particularly for complaints about vaginal bleeding, pain, and wound concerns. Patients in the Contact group were significantly more likely to have diagnoses of chronic pelvic pain (14.2% [n = 47] versus 7.4% [n = 16], p = 0.015) or anxiety and/or depression (34.7% [n = 115] versus 26.4% [n = 57], p = 0.04). Conclusions: The majority of patients undergoing gynecologic surgery seek medical advice via telephone postoperatively, primarily due to new or existing symptoms. A substantial number of these encounters do not require any further management, highlighting areas where patient education can be improved before hospital discharge.

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