Utilizing Telemedicine for Delivery of Postoperative Care
Condition: Laparoscopic Gynecologic Surgery
Study type: Interventional

Summary: 
      The investigators propose a pilot project in which enrolled patients undergoing major
      gynecologic surgery will be randomized to either a traditional office postoperative visit or
      a telemedicine postoperative visit. The two groups will then be compared on a variety of
      metrics including clinical outcomes, patient satisfaction and time.
    

Detailed description: 
      Project title: Utilizing telemedicine for delivery of postoperative care following
      minimally-invasive gynecologic surgery: A randomized controlled trial

      Principal Investigator: Steven Radtke MD FACOG Co-Investigators: Randle Umeh MD Research
      Associate: Martha Chavez, MPA Biostatistician: Zuber Mulla, Ph.D., Professor Affiliations:
      Texas Tech University Health Science Center El Paso, Paul L. Foster School of Medicine

      Background:

      The wide-spread use of minimally invasive techniques in gynecologic surgery has brought
      several tangible benefits to patients including faster-recovery times, shorter hospital
      stays, decreased risk of long term complications, to name a few. 1-3 Technological advances
      such as the development of robotic assistance have allowed to further expand the number of
      cases that can be performed via a minimally invasive approach.4 The shift has been such that
      the landscape regarding operative routes in gynecologic surgery has completely reversed, with
      now the majority of cases being performed laparoscopically. 5 Although much has changed
      intraoperatively, the surrounding structure of an operative has lagged. Specifically,
      preoperative and post-operative visits are still conducted in a similar way than how it was
      done 20 years ago. Despite leaps in technology, the field of gynecologic surgery has been
      slow to widely implement these advances into perioperative practice. One of the specific
      areas of opportunity is the postoperative visit. It is common practice in the majority of
      fields to have a visit with the patient approximately 2 weeks after surgery. The objective of
      this visit is to evaluate how the patient has been progressing, examine the wound site(s),
      and discuss pathology results from any specimens that were removed during the procedure.

      The logistics of this visit involve blocking a time-slot in an established clinic day. The
      patient is required to transport herself to the clinic site. Once checked-in, there may be a
      waiting period before being placed in a room for the practitioner to conduct the visit. Once
      the visit is started, as long as there are no issues, the duration of the interaction may
      range on average between 3-7 minutes.

      Despite these visits being short and usually straight-forward, the invested time that
      patients have to dedicate is substantially greater than the actual interaction with the
      clinician. Furthermore, because of the advantages of minimally invasive surgery, many
      patients have already returned to work by the time of the postoperative visit which may
      result in a disruption of their daily work schedule.

      The ubiquitousness of high-speed internet and mobile phones have allowed for the field of
      telemedicine to thrive in recent years.6,7 Although wide-spread application of this modality
      has not been implemented in the field of gynecologic surgery, other areas such as urology and
      pediatrics have successfully implemented telemedicine programs, specifically for
      postoperative patients, yielding promising results. 8,9 The investigators propose a pilot
      project in which enrolled patients undergoing major gynecologic surgery will be randomized to
      either a traditional office postoperative visit or a telemedicine postoperative visit. The
      two groups will then be compared on a variety of metrics including clinical outcomes, patient
      satisfaction and time.

      Objectives

        1. Determine if there are differences in patient satisfaction between traditional
           postoperative visits and telemedicine postoperative visits

        2. Determine the difference in time invested from the patient's side and clinicians side in
           order to complete the postoperative visit interaction

        3. Analyze if there is a difference between groups regarding visits to the emergency
           department related to the surgery, delayed postoperative complications, etc.

      Hypothesis Patient satisfaction will be greater in the telemedicine group. The total time
      invested will be decreased. There will be no difference in visits to the emergency department
      or unrecognized postoperative complications
    

Intervention name(s): Telemedicine; Office visit
Intervention type(s): Other; Other
Intervention description(s): A video-call application hosted by Texas Tech University Health Science Center El Paso and easily accessible from mobile phones or video-enabled PCs will be used (webex teams); Patient comes to the office to receive routine postoperative care
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research