In-Person Exam Has Little Impact on Virtual Urological Surgery Planning

A recent study found that except for certain urologic conditions, virtual surgical planning for urology patients that occurred through video visits was not influenced by an in-person examination and did not impact surgery plans.

In this study, researchers aimed to determine whether the lack of a prior in-person physical examination and the use of video visits influenced urological surgery planning. The data included in the research represented 590 consecutive urology patients who participated in new patient video visits between March and May 2020 at a single academic center.

The main unit of measurement was procedural plan concordance, defined as the proportion of video visit surgical plans that went unchanged following an in-person visit.

Of the total population, 195 (33 percent) had an initial evaluation from a video visit and a procedure scheduled. Of these 195 patients, 186 (95 percent) had concordant plans following an in-person evaluation; that is, the surgical plan remained unchanged following an in-person exam. 

Also, almost all (99 percent) of the intentions surrounding in-office procedures and 91 percent of operating room procedures were left unchanged.

Of the 186 patients with concordant plans, four (2.1 percent) faced changes in surgical procedures following modifications in a clinical course, two due to additional imaging, and three due to genitourinary examination findings.

Lastly, researchers noted that the number of days between a video visit and an in-person evaluation was more significant among discordant cases compared to concordant cases.

Thus, researchers determined that in-person examination did not significantly affect surgical plans developed during new patient video visits. Nonetheless, several urologic conditions can benefit highly from the genitourinary examination to dictate the surgical approach. Also, in the event of changes in clinical course or imaging, operative plans may change as well.

"A limited physical examination has been a point of controversy regarding telehealth implementation, particularly when assessing for subtle or sensitive findings," they concluded. "Overall, these data support the reliability of [new patient] telehealth surgical plans in the absence of a physical examination. More importantly, this study promotes a better understanding of factors contributing to changes in the plan."

Researchers also noted various limitations to the study,  including the small sample size, biases in urology subspecialties, limited understanding of preexisting data, and study design.

Previously, studies have aimed to determine the effects of initial in-person versus telehealth visits on patient care.

In May, researchers from the Children’s Hospital of Philadelphia found that various pediatric neurology patients require an initial in-person visit. Upon reviewing thousands of telehealth visits, researchers identified what they termed ‘visits of concern’ (VOCs), which they used to categorize data. They defined VOCs as telehealth visits where the patient needed an in-person follow-up sooner than if the initial visit had occurred in person.

They found that the factors that triggered VOCs were mainly related to socioeconomic and racial disparities.