The Lack of a Physical Exam During New Patient Telehealth Visits Does Not Impact Plans for Office and Operating Room Procedures

• Type of Material: Article
• Authors: Nicholas W. Eyrich, Emory University; Juan J. Andino, Michigan Medicine; Roberta E. Ukavew, Michigan Medicine; Mark W. Farha, Michigan Medicine; Akshar K. Patel, Michigan Medicine; Daniel Triner, Michigan Medicine; Chad Ellimootil, Michigan Medicine
• Language: English
• Date: 2022-06-28
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Elsevier Inc. All rights reserved.
• Final Published Version (URL): https://doi.org/10.1016%2Fj.urology.2022.06.017
• Title of Journal or Parent Work: Urology
• Volume: 167
• Start Page: 109
• End Page: 114
• Grant/Funding Information: CE is supported by an Agency for Healthcare Research and Quality K Award (1 K08 HS027632-01).
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management

Abstract

OBJECTIVE To understand how the lack of a physical examination during new patient video visits can impact urological surgery planning during the COVID-19 pandemic. METHODS We retrospectively reviewed 590 consecutive urology patients who underwent new patient video visits from March through May 2020 at a single academic center. Our primary outcome was procedural plan concordance, the proportion of video visit surgical plans that remained the same after the patient was seen in-person, either in clinic or on day of surgery. Median days between video and in-person visits were compared between concordant and discordant cases using the Mann-Whitney U test; P < .05 was significant. RESULTS Overall, 195 (33%) were evaluated by new patient video visits and had a procedure scheduled, of which, 186 (95%) had concordant plans after in-person evaluation. Further, 99% of plans for in-office procedures and 91% for operating room procedures were unchanged. Four patients (2.1%) had surgical plans altered after changes in clinical course, two (1%) due to additional imaging, and three (1.5%) based on genitourinary examination findings. Days between video visit and in-person evaluation did not differ significantly in concordant cases (median 37.5 [IQR, 16 - 80.5]) as compared to discordant cases (median 58.0 [IQR, 20 - 224]; P = .12). CONCLUSIONS Most surgical plans developed during new patient video visits remain unchanged after in-person examination. However, changes in clinical course or updated imaging can alter operative plans. Likewise, certain urologic conditions (eg, penile cancer) rely on the genitourinary examination to dictate surgical approach.