Hello everyone! Here comes the first #IUJTweetorial from @IUJ_BlueJournal! The study will be "Outpatient visits versus telephone interviews for postoperative care: a randomized controlled trial", published last year. rdcu.be/b3NZO - 1/16
Healthcare in the US is expensive and quality care must be included in this package. It incorporates clinical outcomes, safety, and patient satisfaction. The need of routine, in-person post-op visits is unknown. 2/16
▶️Telephone-based postop care provides safe and effective care with ⬇️ global scales.
▶️300k+ surgeries for pelvic organ prolapse (POP) each year in US
▶️Authors aimed a non-inferiority, RCT comparing routine postop outpatient clinic x telephone calls. 3/16
▶️300k+ surgeries for pelvic organ prolapse (POP) each year in US
▶️Authors aimed a non-inferiority, RCT comparing routine postop outpatient clinic x telephone calls. 3/16
Eligibility criteria: women >18y to undergo POP surg, with reliable phone number, ability to give consent and understand English or Spanish
Exclusion criteria: pregnant or incarcerated or if the surgeon decided that F/U was needed to be in-person
4/16
Exclusion criteria: pregnant or incarcerated or if the surgeon decided that F/U was needed to be in-person
4/16
Randomization:simple computer-generated scheme, at P/O discharge-ITT analysis.
Allocation:sequentially numbered, sealed, opaque 📩
🥇 outcome: pt satisfaction – S-CAHPS (Consumer Assessment of Health Providers and Systems Surgical Care Surgery) 5/16
Allocation:sequentially numbered, sealed, opaque 📩
🥇 outcome: pt satisfaction – S-CAHPS (Consumer Assessment of Health Providers and Systems Surgical Care Surgery) 5/16
S-CAHPS is overseen by US Agency for Healthcare Research and Quality (AHRQ) - cahps.ahrq.gov - 7 composites:
1 – Info to prepare for surgery;
2 – Surgeon communication preop period
3 – Surgeon attentiveness on the day of surgery;
6/16
1 – Info to prepare for surgery;
2 – Surgeon communication preop period
3 – Surgeon attentiveness on the day of surgery;
6/16
7/16
4 – Info to help during recovery
5 – Surgeon communication after surgery;
6 – Quality of office staff
7 – Overall surgeon rating
4 – Info to help during recovery
5 – Surgeon communication after surgery;
6 – Quality of office staff
7 – Overall surgeon rating
🥈 analysis: safety (adverse outcomes, Clavien-Dindo scale, pt-reported, unscheduled visits to ER) and clinical outcomes Pelvic Floor Distress Inventory-20 (PFDI-20) and pain scales.
8/16
8/16
9/16
Sample size: S-CAPS scores for the global response score: 90% to represent success in both control and experimental groups, 80% power, alpha 0.025, 15% non-inferior limit: 100 pts, 50 each group.
Sample size: S-CAPS scores for the global response score: 90% to represent success in both control and experimental groups, 80% power, alpha 0.025, 15% non-inferior limit: 100 pts, 50 each group.
10/16
F/U intervals (1-2,6 and 12 wks) = adverse events (AE´s) and unscheduled emergency and PC visits.
At 3 mo = final S-CAHPS, PFDI-20 and pain scales administered
F/U intervals (1-2,6 and 12 wks) = adverse events (AE´s) and unscheduled emergency and PC visits.
At 3 mo = final S-CAHPS, PFDI-20 and pain scales administered
11/16
430 pts had preop appointments – 120 enrolled – 17 withdrawn– 103 were randomized Final count: 50/50 for each group completed S-CAHPS.
430 pts had preop appointments – 120 enrolled – 17 withdrawn– 103 were randomized Final count: 50/50 for each group completed S-CAHPS.
12/16
Demographics similar between groups, 48% Hispanic. Outpatient sx: MUS, sacral neuromodulation, cysto, #mesh excision, Intravesical botulinum toxin, lap Burch, colporrhaphy.In-patient sx:native tissue POP repair, sacrocolpopexy,colpocleisis,fascial sling
Demographics similar between groups, 48% Hispanic. Outpatient sx: MUS, sacral neuromodulation, cysto, #mesh excision, Intravesical botulinum toxin, lap Burch, colporrhaphy.In-patient sx:native tissue POP repair, sacrocolpopexy,colpocleisis,fascial sling
13/16
The S-CAHPS did not present any # between groups, except for question M5, about how well the surgeon communicates with pts after surgery – this composite showed inferiority – pts were mostly communicating with the nurse rather than their physician.
The S-CAHPS did not present any # between groups, except for question M5, about how well the surgeon communicates with pts after surgery – this composite showed inferiority – pts were mostly communicating with the nurse rather than their physician.
14/16
AE´s no # between groups. Telephone postop care did not increase frequency of emergency or PC visits. PFDI-20 scores improved in both groups with no # between them. Pain scores did not # between groups.
AE´s no # between groups. Telephone postop care did not increase frequency of emergency or PC visits. PFDI-20 scores improved in both groups with no # between them. Pain scores did not # between groups.
15/16
Limitations of the study – was not powered to evaluate other parts of postop experience, such as delayed ureteral injury. Selection bias: recruited pts lived 40+ miles far from the hospital
Limitations of the study – was not powered to evaluate other parts of postop experience, such as delayed ureteral injury. Selection bias: recruited pts lived 40+ miles far from the hospital
16/16
Strengths – novel approach to post-op care and itr thorough assessment of health care quality in the post-op setting. Reduction in outpatient visits – improving costs and decrease bureaucracy.
Strengths – novel approach to post-op care and itr thorough assessment of health care quality in the post-op setting. Reduction in outpatient visits – improving costs and decrease bureaucracy.
I hope you have enjoyed the experience and give us some feedback! Thanks to @lgobrito and to other inspiring SoMe Editors - @Reprod_Health @SpringerRepBio @AAGLJMIG @FPMRS @RrogersG @iujeicswift @LJMacMurray @paging_DrGarcia
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