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子宫切除术后远程医疗与门诊术后随访的随机对照试验

Telehealth vs Clinic Postoperative Visit After Hysterectomy: A Randomized Controlled Trial.

作者信息

Wherley Susan D, Sheyn David, Hellerstein Leah H, Bauer Hope, Mangel Jeffrey, Sears Sarah, Shiber Linda-Dalal, Pollard Robert

机构信息

Urogynecology and Reconstructive Pelvic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.

Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA.

出版信息

Int Urogynecol J. 2025 Jan 31. doi: 10.1007/s00192-025-06070-9.

Abstract

INTRODUCTION AND HYPOTHESIS

Telehealth is becoming more common, but there is a paucity of literature investigating the role of telehealth in perioperative gynecologic care. The authors hypothesized that patients evaluated via telehealth 4 weeks after minimally invasive hysterectomy would not have lower satisfaction than patients evaluated in clinic.

METHODS

This was a randomized controlled noninferiority trial of patients who underwent minimally invasive hysterectomy at a single academic medical center. Participants were randomized to postoperative clinic visit or telehealth visit 4 weeks after hysterectomy. After the 4-week postoperative visit, patients were sent a satisfaction questionnaire. The primary outcome was overall patient satisfaction on a 100 mm visual analog scale. Secondary outcomes were 90-day postoperative complications and unplanned events.

RESULTS

One hundred one patients who underwent minimally invasive hysterectomy were identified for inclusion. Complete data were collected for 47 in the clinic group and 45 in the telehealth group. 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 clinic two or more times (p = 0.02); both groups were similarly likely to contact the clinic at least once (57.4% vs. 51.1%). Postoperative complications did not differ between groups, nor did unplanned clinic visits or emergency department (ED) visits.

CONCLUSIONS

Postoperative visit satisfaction of patients evaluated via telehealth was noninferior to the satisfaction of patients seen in the clinic 4 weeks after minimally invasive hysterectomy. Unplanned clinic visits and ED visits did not differ between groups, nor did 90-day postoperative complications.

摘要

引言与假设

远程医疗正变得越来越普遍,但研究远程医疗在围手术期妇科护理中作用的文献却很匮乏。作者假设,在微创子宫切除术后4周通过远程医疗进行评估的患者,其满意度不会低于在诊所接受评估的患者。

方法

这是一项针对在单一学术医疗中心接受微创子宫切除术患者的随机对照非劣效性试验。参与者被随机分为术后4周进行门诊复诊或远程医疗复诊。术后4周复诊后,向患者发送满意度调查问卷。主要结局是患者在100毫米视觉模拟量表上的总体满意度。次要结局是术后90天的并发症和意外事件。

结果

确定了101例接受微创子宫切除术的患者纳入研究。诊所组47例和远程医疗组45例收集到了完整数据。两组术后复诊的总体满意度无差异(诊所组94.3分,远程医疗组92.0分,p = 0.47)。诊所组患者联系诊所两次或更多次的可能性显著更高(p = 0.02);两组患者至少联系诊所一次的可能性相似(57.4%对5l.1%)。两组术后并发症、计划外门诊就诊或急诊科就诊情况均无差异。

结论

微创子宫切除术后4周通过远程医疗进行评估的患者,其术后复诊满意度不劣于在诊所接受评估的患者。两组在计划外门诊就诊和急诊科就诊情况以及术后90天并发症方面均无差异。

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