Outpatient visits versus telephone interviews for postoperative care: a randomized controlled trial
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.
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.
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).
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.
KeywordsPostoperative care Patient satisfaction Telephone visits
Compliance with ethical standards
Conflicts of interest
This project was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences of the National Institutes of Health through Grant Number UL1TR001449. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
This project was funded by the University of New Mexico’s ObGyn department Seligman Fund and the Clinical & Translational Science Center (CTSC) Pilot Grant.
J.C. Thompson, S.B. Cichowski, F. Qeadan, J. Zambrano, C. Wenzl, P.C. Jeppson report no conflict of interest.
G.C. Dunivan receives research support from Pelvalon, Inc. unrelated to the submitted work.
R.G. Rogers is DSMB chair for the TRANSFORM trial sponsored by American Medical Systems and receives royalties for scientific writings from UptoDate. She receives travel and stipend from IUGA for editor in chief services for IUJ and from ABOG for work for the board.
Y.M. Komesu reports grants from NIH (grant #PA11-260), nonfinancial support from National Center for Research Resources and the National Center for Advancing Translational Sciences of the National Institutes of Health through grant no. 8UL1TR000041, The University of New Mexico Clinical and Translational Science Center, grants from NIH: U grant funding the Pelvic Floor Support Disorders Network via the Eunice Kennedy Shriver NICHD institute.