Telehealth vs. Clinic Postoperative Visit After Minimally Invasive Hysterectomy

Objectives: Telehealth, or the provision of medical care at a distance using technology, is becoming increasingly common, partly due to the SARS-CoV-2 pandemic. Known benefits of telehealth include improved access to care, convenience for patients, and savings of time and cost without sacrificing quality of care or patient satisfaction. However, there is a paucity of literature investigating the role of telehealth in perioperative care of gynecologic patients. The aim of this study was to assess whether patient satisfaction, postoperative complications, and unplanned visits differ between postoperative hysterectomy patients evaluated via telehealth and in clinic. The authors hypothesized that postoperative patients evaluated via telehealth four weeks after minimally invasive hysterectomy would not have lower satisfaction than patients evaluated in clinic.

Methods: This was a randomized controlled noninferiority trial of adult patients who underwent minimally invasive hysterectomy for non-oncologic indications between August 2022 and July 2023 at a single academic medical center. Exclusion criteria included lack of reliable access to a smartphone, inability to complete a questionnaire in English, intraoperative injury, blood transfusion, postoperative stay greater than one day, and diagnosis of occult cancer on pathology. The primary outcome was overall patient satisfaction on a 100 mm visual analog scale. Secondary outcomes were 90-day postoperative complications and unplanned events, including office calls or MyChart messages, office visits, emergency department visits, and hospital admissions. The electronic medical record was used to identify patients and abstract demographic information, surgical characteristics, postoperative complications, and unplanned events. All analysis was performed by the intention-to-treat principle. Descriptive statistics are expressed as means with standard deviations. Pairwise analysis was performed using Student's t-test, Wilcoxon Rank-sum and Fisher's exact test as appropriate.

Results: 101 patients who underwent minimally invasive hysterectomy were identified for inclusion. Complete data were collected for 92 patients, 47 in the office group and 45 in the telehealth group. Demographics were not significantly different between groups, with the exception that more patients in the clinic group had a BMI ≥ 40. Overall postoperative visit satisfaction did not differ between groups (94.3 clinic vs. 92.0 telehealth, p=0.47). The clinic group was significantly more likely to contact the office two or more times (p=0.02), though both groups were similarly likely to contact the office at least once (57.4% vs. 51.1%). Postoperative complications did not differ between groups, nor did unplanned office visits or emergency department visits. No readmissions occurred.

Conclusions: Postoperative visit satisfaction of patients evaluated via telehealth was noninferior to the satisfaction of patients seen in the clinic four weeks after minimally-invasive hysterectomy. Unplanned office visits and ED visits did not differ between groups, nor did 90-day postoperative complications. This study demonstrates that postoperative telehealth visits are a viable alternative to clinic visits for appropriate patients.