Outpatient visits versus telephone interviews for postoperative care: a randomized controlled trial

• Published in: International Urogynecology Journal 2019-10, Vol.30 (10), p.1639-1646
• Main Authors: Thompson, Jennifer C., Cichowski, Sara B., Rogers, Rebecca G., Qeadan, Fares, Zambrano, Julissa, Wenzl, Cynthia, Jeppson, Peter C., Dunivan, Gena C., Komesu, Yuko M.
• Format: Article
• Language: English
• Subjects: Aged; Clinical outcomes; Female; Gynecologic Surgical Procedures - rehabilitation; Gynecology; Humans; Medicine; Medicine & Public Health; Middle Aged; Original Article; Patient satisfaction; Patient Satisfaction - statistics & numerical data; Pelvic Floor Disorders - rehabilitation; Pelvic Floor Disorders - surgery; Postoperative Care - methods; Postoperative period; Surgeons; Surgery; Telerehabilitation; Urology
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-019-03895-z

Introduction and hypothesis Our aim was to determine whether postoperative telephone follow-up was noninferior to in-person clinic visits based on patient satisfaction. Secondary outcomes were safety and clinical outcomes. Methods Women scheduled for pelvic surgery were recruited from a single academic institution and randomized to clinic or telephone follow-up. The clinic group returned for visits 2, 6, and 12 weeks postoperatively and the telephone group received a call from a nurse at the same time intervals. Women completed the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS) questionnaire, Pelvic Floor Distress Inventory (PFDI)-20, and pain scales prior to and 3 months postoperatively. Randomized patients who completed the S-CAHPS at 3 months were included for analysis. Sample size calculations, based on a 15% noninferiority limit in the S-CAHPS global assessment surgeon rating, required 100 participants, with power = 80% and alpha = 0.025. Results From October 2016 to November 2017, 100 participants were consented, underwent surgery, were randomized, and included in the final analysis (clinic group n  = 50, telephone group n  = 50). Mean age was 58.5 ± 12.2 years. Demographic data and surgery type, dichotomized into outpatient and inpatient, did not differ between groups. The S-CAHPS global assessment surgeon rating from patients in the telephone group was noninferior to the clinic group (92 vs 88%, respectively, rated their surgeons 9 and10, with a noninferiority limit of 36.1; p  = 0.006). Adverse events did not differ between groups ( n  = 26; 57% fclinic vs 43% telephone; p  = 0.36). Patients in the telephone group did not require additional emergency room or primary care visits. Clinical outcome measures improved in both groups, with no differences (all p  > 0.05). Conclusions Telephone follow-up after pelvic floor surgery results in noninferior patient satisfaction, without differences in clinical outcomes or adverse events. Telephone follow-up may improve healthcare quality and decrease patient and provider burden for postoperative care. Clinical trial registration ClinicalTrials.gov , www.clinicaltrials.gov , NCT02891187.