Video Virtual Clinical Encounters Versus Office Visits for Postoperative Care After Pelvic Organ Prolapse Surgery: A Randomized Clinical Trial

Abstract

Objectives To determine if patient satisfaction of virtual clinical encounters is noninferior to traditional in-office clinical encounters for postoperative follow-up after reconstructive surgery for pelvic organ prolapse. Methods This was a randomized controlled noninferiority trial of women undergoing surgery for pelvic organ prolapse. Women were recruited and randomized during their preoperative counseling visit to virtual clinical encounters via video conference technology or in-office clinical encounters for their 30-day postoperative follow-up visits. The primary outcome was patient satisfaction measured by the validated Patient Satisfaction Questionnaire-18 (score range, 18–90, with higher scores indicating greater satisfaction) administered by telephone following the 30-day visit. Additional information regarding demographics, postoperative health care utilization, and complications was collected via chart review and compared between groups. Results A total of 52 women were randomly assigned to virtual clinical encounters via videoconference technology or traditional in-office clinical encounters (26 per group). The mean patient satisfaction score was 80.7 ± 2.6 in the virtual group and 81.2 ± 2.8 in the office group (difference, −0.46 points; 95% confidence interval, −1.95 to 1.03), which was consistent with noninferiority. Postoperative complication rates were 31% in the virtual group and 46% in the office group (P = 0.3). There were no significant between-group differences in secondary measures of unscheduled telephone calls (88% versus 77%, P = 0.5) and office visits (35% versus 38%, P = 0.8), emergency room visits (15% versus 19%, P = 1.0), and hospital readmissions (4% versus 12%, P = 0.6) within 90 days of surgery. Conclusions For patients with pelvic organ prolapse undergoing reconstructive surgery, postoperative virtual clinical encounters via video conference technology are noninferior to traditional in-office clinical encounters with high levels of short-term patient satisfaction and no differences in postoperative health care utilization and complications rates.

The role of telemedicine in minimally invasive gynecologic surgery

“…With the massive expansion of telemedicine being so recent, data evaluating the impact in OB/GYN are limited, but initial studies in prenatal care and family planning indicate successful implementation with equivalent outcomes to all in-person care [12,13]. One trial in gynecologic surgery demonstrated no difference in satisfaction, complication rates or unscheduled telephone visits, hospital readmissions, or emergency room visits [14 ▪▪ ]. Provider ratings in our practice were similar between in-person and virtual appointments, particularly later in the pandemic when providers, patients, and electronic health records (EHRs)s had greater experience with telemedicine [15].…”

Evidence for the Appropriate Use of Telemedicine in Female Pelvic Medicine and Reconstructive Surgery

“…The authors concluded that patient satisfaction with televisits was non-inferior to traditional office postoperative visits and were reasonable alternatives for women undergoing prolapse surgery. [ 20 ]…”

No pelvic exam, no problem: patient satisfaction following the integration of comprehensive urogynecology telemedicine

“…The first publication regarding the use of mobile technology in urogynecology did report that patients were willing to use telemedicine [6]. Additionally, randomized controlled trials have since evaluated postoperative urogynecology visits, by both telephone [7] and video [8], compared to traditional in-office visits, and both investigators found telemedicine visits non-inferior to standard office visits in terms of satisfaction and patient outcomes. However, it is unknown whether telemedicine can be applied to a broader range of urogynecologic conditions without compromising patient satisfaction.…”