MP30-17 TELEMEDICINE OPTIMIZES EARLY POST-OPERATIVE FOLLOW UP AFTER SYNTHETIC MID-URETHRAL SLING (MUS): A RANDOMIZED MULTI-INSTITUTIONAL CONTROL TRIAL

Abstract

Introduction: The female stress urinary incontinence (SUI) American Urological Association (AUA) guidelines state physicians should communicate with patients soon after surgery. However if patients are doing well, do they need physical examination? We assessed whether telemedicine based follow up (TBFU) is equivalent to office based follow-up (OBFU) in the early Postoperative period after routine synthetic mid-urethral placement with regard to unplanned events and patient reported outcomes. Methods: We conducted a prospective, international, multi-institutional, randomized control trial from 2018-9. All patients underwent a MUS for documented SUI or stress-predominant mixed urinary incontinence. Patients were randomized 1:1 to 3-week postoperative OBFU or TBFU; patient-requested crossover between groups was permitted. OBFU at 3 to 5 months was recommended for all. The primary outcome was the rate of unplanned events by follow up method. Secondary outcomes included rate of patient satisfaction, crossover, and compliance with 3 to 5 month OBFU. Descriptive statistics and logistic regression analyses were used to assess our data. Results: 222 patients were enrolled from 5 sites (TBFU:115 vs. OBFU: 107). Mean age was 56 years (Range, 34-87), and BMI was 26.3 (STD: 4.5). The majority of the sample was Asian (49%) or White (44.6%). No differences in demographics or medical comorbidities were noted between the study groups (p: 0.26-0.88). Comparing TBFU to OBFU, no differences were noted in unplanned events - hospital admission, emergency department visit, or unplanned office visit or call (15% vs. 15.7%, P = 0.89) or adverse medical events (9.3% vs. 10.4%, P = 0.83). TBFU patients were more likely to be 'very satisfied' with their surgical outcomes (75.7% vs. 64.5%, P = 0.32); these differences were not statistically significant. Predictors of satisfaction included non-white ethnicity (P < 0.01; OR: 1.9, 95% CI: 0.94-4.0) and no college-level education (P = 0.02; OR: 1.2, 95% CI: 0.25- 6.2). Sixteen (14%) TBFU patients requested crossover to OBFU; age > 65 was predictive of crossover (P = 0.04; OR: 3.3, 95% CI: 1.1-9.9). TBFU patients were more compliant with 3 to 5 month OBFU (93.8% vs. 84.6%, P = 0.03) Conclusion: After synthetic MUS placement, TBFU is a safe, feasible patient communication option 3 weeks postoperatively. Compared to OBFU, TBFU had no greater unplanned events, greater compliance with 3 to 5 month follow up, and trended towards higher satisfaction.