Surgical Planning Via Telehealth Consultation Is Effective for Patients Undergoing Minimally Invasive Gynecologic Surgery

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Study Objective To determine if the proposed treatment plan created for new patients during telehealth consultation concurred with the treatment plan at the subsequent in-person visit. Our secondary objectives were to determine the average time of telehealth consultation and perioperative safety. Design Retrospective cohort. Setting New patient telehealth consultations during COVID pandemic. Patients or Participants Women undergoing telehealth evaluation at a minimally invasive gynecologic surgical practice, with subsequent in-person examination. Interventions N/A. Measurements and Main Results The primary outcome was concurrence of treatment plan (surgical or conservative) during the initial telehealth visit with plan made at the in-person examination. Between April and November 2020, 148 women completed new patient phone visits, and 10 completed new patient video visits. When pandemic restrictions were lifted, patients returned for in-person exam to confirm the treatment plan of surgery or conservative management. During the telehealth consultation, 138 women (87.3%) elected for surgical treatment and 111 returned for in-person follow up. 20 women (12.7%) elected for conservative treatment; four returned for in-person follow up and two changed to a surgical plan. Overall concordance between treatment plan made at initial telehealth consultation and in-person visit was 96.5% (p<0.01). Of those who elected for surgery at initial consultation and completed in-person examination, 110 had surgery (99.1% concordance.) Of those who planned conservative management at initial consultation and completed in-person examination, two proceeded with conservative management (50% concordance.) Visit duration was obtained from billing notation and was 30.4±9.7min. Ultimately, 112 women underwent surgery with few complications. There were two intraoperative complications: one EBL > 500mL and one cystotomy. Postoperatively, three women (1.9%) developed a surgical site infection, four (2.5%) were diagnosed with a urinary tract infection, and one (0.6%) returned to the OR for small bowel obstruction. Conclusion Telehealth consultations performed at a minimally invasive gynecologic surgery practice are an effective modality for safe surgical planning. To determine if the proposed treatment plan created for new patients during telehealth consultation concurred with the treatment plan at the subsequent in-person visit. Our secondary objectives were to determine the average time of telehealth consultation and perioperative safety. Retrospective cohort. New patient telehealth consultations during COVID pandemic. Women undergoing telehealth evaluation at a minimally invasive gynecologic surgical practice, with subsequent in-person examination. N/A. The primary outcome was concurrence of treatment plan (surgical or conservative) during the initial telehealth visit with plan made at the in-person examination. Between April and November 2020, 148 women completed new patient phone visits, and 10 completed new patient video visits. When pandemic restrictions were lifted, patients returned for in-person exam to confirm the treatment plan of surgery or conservative management. During the telehealth consultation, 138 women (87.3%) elected for surgical treatment and 111 returned for in-person follow up. 20 women (12.7%) elected for conservative treatment; four returned for in-person follow up and two changed to a surgical plan. Overall concordance between treatment plan made at initial telehealth consultation and in-person visit was 96.5% (p<0.01). Of those who elected for surgery at initial consultation and completed in-person examination, 110 had surgery (99.1% concordance.) Of those who planned conservative management at initial consultation and completed in-person examination, two proceeded with conservative management (50% concordance.) Visit duration was obtained from billing notation and was 30.4±9.7min. Ultimately, 112 women underwent surgery with few complications. There were two intraoperative complications: one EBL > 500mL and one cystotomy. Postoperatively, three women (1.9%) developed a surgical site infection, four (2.5%) were diagnosed with a urinary tract infection, and one (0.6%) returned to the OR for small bowel obstruction. Telehealth consultations performed at a minimally invasive gynecologic surgery practice are an effective modality for safe surgical planning.