Preferred method of two week post operative follow up after pelvic reconstructive surgery. (phone callversus clinic visit): A randomized clinical trial

ABSTRACT

Objective: There is no current standardization of when and how postoperative follow up visits are completed after pelvic reconstructive surgery. Telemedicine visits are favorable amongst patients and have been associated with increased patient satisfaction, less waiting time, and reduced travel costs. The COVID-19 pandemic highlighted the importance of telemedicine visits. Prior to the pandemic, we designed a Randomized Control Trial with primary aim to investigate if patient satisfaction with telephone visit was non-inferior to clinic visits post operatively at two weeks. Secondary aims were to investigate if the telehealth postoperative visit is a safe alternative to clinic visits. Methods: This was an IRB approved randomized controlled trial investigating patient satisfaction with the use of telephone visits for two week post surgery follow up. Inclusion criteria included women undergoing pelvic reconstructive surgery. Eligiblewomen were randomized to either a two-week postoperative telephone visit or two-week postoperative clinic visit. Primary outcome was satisfaction with two week postoperative visit as defined by answering 'strongly agree' on Likert scale. Sample sizes of 71 women in each group was needed in order to achieve an 80% power to detect a non-inferiority margin difference of 12% between groups. The clinic visits were completed by physicians and the telephone visits were completed by the clinic nurses with a scripted guideline for all patients including need for triage to clinic visits. Patients completed a non-validated patient satisfaction questionnaire and patient global impression of improvement at their six-week post op visit. Statistical analysis was performed using P-value for independent samples ttest/ Wilcoxon-Mann-Whitney for continuous variables or chi-square/Fisher's exact test for categorical variables to determine statistical significance. Results: A total of 67 patients were recruited between July 2018 to March 2020, 21 patients declined to participate. There were 36 patients in the clinic arm and 31 patients in the telephone arm. Due to the Covid-19 pandemic, most clinic postoperative visits were converted to telehealth visits and elective surgeries were cancelled. The study was halted in March 2020 and did not reach its prior power calculation of 71 per group. There was no difference seen in patient satisfaction with postoperative visits between the two groups. The results of the non-validated questionnaire showed that patients who had telephone visits were likely to be satisfied with telephone visits and would prefer telephone visits in the future when compared to those who had clinic visits. Conversely, patients who had clinic visits were likely to be satisfied with in person visits and were more likely to prefer those in the future. (P < 0.001, Table 2) For validated questionnaires such as PGI-I there was no difference between groups. For secondary outcomes there was no difference in emergency visits, hospital readmissions, or postoperative complications between the two groups. Clinic visits lasted longer than telephone visits (15 mins vs 6 mins, Table 3). Conclusions: Two week postoperative telephone visits were well received by patients, resulted in shorter visit length, had high patient satisfaction and PGI scores, and are a safe alternative to clinic visits with no difference in adverse outcomes. Given the recent pandemic, it is important that we continue to design future studies to evaluate telemedicine in patient care for FPMRS.