The Impact of Exclusively Virtual Preoperative Evaluation on Complications of Gynecologic Surgery

Study Objective: To evaluate the impact of virtual versus in-person preoperative evaluation on perioperative complication rates in a minimally invasive gynecologic surgery (MIGS) practice. Design: Retrospective cohort study. Setting: Quaternary care academic hospital in the United States. Participants: Patients who underwent surgery with a MIGS surgeon between January 2016 and May 2023. Interventions: Patients underwent either in-person or virtual preoperative visits (defined as the initial consultation and any subsequent follow-up or preoperative counseling visits). Those who had both an in-person and virtual preoperative visit were excluded. Complication rates among the virtual and in-person cohorts were compared, and logistic regression was performed to adjust for potential confounders. Results: The analysis included 2,947 patients, 1196 (40.6%) with exclusively virtual preoperative visits and 1751 (59.4%) with exclusively in-person visits. Following the implementation of telemedicine in 3/2020, 80.6% of patients had all their preoperative visits conducted virtually via videoconference. Surgical approach included conventional laparoscopy (78.8%), robotic-assisted laparoscopy (3.8%), laparotomy (2.1%), and other gynecologic procedures without abdominal entry (15.3%). The most common procedures were endometriosis excision (43.1%), myomectomy (34.0%), and hysterectomy (24.8%). Composite perioperative complication rates were similar between cohorts (5.9% virtual vs 6.3% in-person, adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.58–1.17). There were no significant differences for major complications (2.3% virtual vs 1.2% in-person, aOR 1.52, 95% CI 0.85–2.74) or minor complications (5.7% virtual vs 6.1% in-person, aOR 0.83, 95% CI 0.59–1.19). Conversion to laparotomy was rare in both groups (0.1% virtual vs 0.2% in-person). Conclusion: Implementation of virtual preoperative visits within a MIGS practice did not impact composite surgical complication rates. For subspecialized gynecologic surgeons, a virtual preoperative evaluation may offer a safe alternative to the traditional in-person visit.