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The investigators propose utilizing a simple telemedical protocol to allow patients to substitute the first post-operative visit with a remote survey that includes essential post-operative history, vision measurement, and photographs, all of which can be provided using a personal computer, tablet, or smart phone. The investigators have selected for this purpose a subset of oculoplastic procedures involving the eyelid and lacrimal system that have well-reported low rates of serious complications, since high-risk procedures will likely always require close, in-person care. The investigators hypothesize that telemedicine follow-up for the first post-operative week after low-risk oculoplastic surgery will decrease the time burden on patients without compromising their satisfaction or increase the risk of late post-operative complications.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Telemedicine | Experimental | Patients in the telemedicine arm will have their post-operative week one visit via a telemedicine portal. |
|
| Routine | No Intervention | Patient in the routine arm will have their post-operative week one visit in clinic. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Telemedicine follow-up | Other | A telemedicine follow-up form based in REDCap that collects information from the patient including: history, photographs, vision measurement, and questions. |
| Measure | Description | Time Frame |
|---|---|---|
| FACE-Q 'Satisfaction with Outcome' | A patient-reported outcome measure assessing satisfaction with the surgical outcome. | Approximately 3 months post-operatively |
| Measure | Description | Time Frame |
|---|---|---|
| FACE-Q 'Early Life Impact' | A patient-reported outcome measure assessing early life impact of facial plastic surgery. | Approximately 1 week post-operatively |
| FACE-Q 'Satisfaction with Doctor' | A patient-reported outcome measure assessing satisfaction with the surgeon. |
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Inclusion Criteria:
Are age 18 years or older
Are fluent in English
Own or have ready access to a smart phone, tablet, or personal computer with high speed internet
Participate in an informed consent process with the surgeon(s) including documentation of written informed consent
Are undergoing a low-risk* eyelid procedure in a clinic, ambulatory surgery center, or hospital operating room setting, including but not limited to:
(*)These listed procedures have a low reported rate of serious complications including vision loss, infection, severe bleeding, or death; however, surgical risk is ultimately determined by the surgeon on a per-patient basis, except in those cases specifically excluded in the subsequent section.
Exclusion Criteria:
Are under the age of 18 years
Are incarcerated
Are pregnant or plan to become pregnant during the period of surgery and 3 month recovery (however these patients are not eligible for elective eyelid surgery)
Are not fluent in English
Do not have access to or do not feel comfortable using a smart phone, tablet, or personal computer
Lack personal capacity for consent (i.e. those patients requiring consent for the surgery by a legal representative are excluded)
Experience a serious intra-operative complication (this criterion is assessed after initial consent)
Are undergoing eyelid or other oculoplastic procedures that are deemed greater than low-risk for serious complications, including but not limited to:
Notably, patients undergoing greater than low risk procedures listed here are absolutely excluded from this trial. Surgeon assessment of individual patient surgical risk only applies to those typically low-risk procedures listed in the previous section on inclusion criteria; reasons for escalation of risk level include patient characteristics (e.g. frailty, previous infection or wound dehiscence), re-operation/revision status, or other factors.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Davin C Ashraf, MD | Contact | 415-353-2800 | davin.ashraf@ucsf.edu |
| Name | Affiliation | Role |
|---|---|---|
| Davin C Ashraf, MD | University of California, San Francisco | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of California, San Francisco | San Francisco | California | 94143 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28328635 | Background | Vyas KS, Hambrick HR, Shakir A, Morrison SD, Tran DC, Pearson K, Vasconez HC, Mardini S, Gosman AA, Dobke M, Granick MS. A Systematic Review of the Use of Telemedicine in Plastic and Reconstructive Surgery and Dermatology. Ann Plast Surg. 2017 Jun;78(6):736-768. doi: 10.1097/SAP.0000000000001044. | |
| 23842982 | Background |
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Only plan to share in the event that journal requests de-identified data to be released.
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| ID | Term |
|---|---|
| D005141 | Eyelid Diseases |
| D001763 | Blepharoptosis |
| D003483 | Cutis Laxa |
| D004483 | Ectropion |
| D004774 | Entropion |
| D005142 | Eyelid Neoplasms |
| ID | Term |
|---|---|
| D005128 | Eye Diseases |
| D012873 | Skin Diseases, Genetic |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
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Randomization to telemedicine follow-up versus routine in-person follow-up for the 1 week assessment after low-risk oculoplastic surgery.
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| Approximately 3 months post-operatively |
| Late post-operative complications | Investigator-reported post-operative complications. | Between the first and second post-operative visits (approximately 1 week to 3 months) |
| Time burden | Patient-reported time spent on the first post-operative visit, including waiting, travel, the visit, and all forms. | Approximately 1 week post-operatively |
| Hwa K, Wren SM. Telehealth follow-up in lieu of postoperative clinic visit for ambulatory surgery: results of a pilot program. JAMA Surg. 2013 Sep;148(9):823-7. doi: 10.1001/jamasurg.2013.2672. |
| 27545100 | Background | Kummerow Broman K, Roumie CL, Stewart MK, Castellanos JA, Tarpley JL, Dittus RS, Pierce RA. Implementation of a Telephone Postoperative Clinic in an Integrated Health System. J Am Coll Surg. 2016 Oct;223(4):644-51. doi: 10.1016/j.jamcollsurg.2016.07.010. Epub 2016 Aug 18. |
| 20679407 | Background | Robaldo A, Rousas N, Pane B, Spinella G, Palombo D. Telemedicine in vascular surgery: clinical experience in a single centre. J Telemed Telecare. 2010;16(7):374-7. doi: 10.1258/jtt.2010.091011. Epub 2010 Aug 2. |
| 29963556 | Background | Williams AM, Bhatti UF, Alam HB, Nikolian VC. The role of telemedicine in postoperative care. Mhealth. 2018 May 2;4:11. doi: 10.21037/mhealth.2018.04.03. eCollection 2018. |
| 12867404 | Background | Carter SR, Stewart JM, Khan J, Archer KF, Holds JB, Seiff SR, Dailey RA. Infection after blepharoplasty with and without carbon dioxide laser resurfacing. Ophthalmology. 2003 Jul;110(7):1430-2. doi: 10.1016/S0161-6420(03)00447-0. |
| 22186506 | Background | Chang S, Lehrman C, Itani K, Rohrich RJ. A systematic review of comparison of upper eyelid involutional ptosis repair techniques: efficacy and complication rates. Plast Reconstr Surg. 2012 Jan;129(1):149-157. doi: 10.1097/PRS.0b013e318230a1c7. |
| 19300151 | Background | Lee EW, Holtebeck AC, Harrison AR. Infection rates in outpatient eyelid surgery. Ophthalmic Plast Reconstr Surg. 2009 Mar-Apr;25(2):109-10. doi: 10.1097/IOP.0b013e3181994124. |
| 21239669 | Background | Mejia JD, Egro FM, Nahai F. Visual loss after blepharoplasty: incidence, management, and preventive measures. Aesthet Surg J. 2011 Jan;31(1):21-9. doi: 10.1177/1090820X10391212. |
| 22402697 | Background | Kam KY, Cole CJ, Bunce C, Watson MP, Kamal D, Olver JM. The lateral tarsal strip in ectropion surgery: is it effective when performed in isolation? Eye (Lond). 2012 Jun;26(6):827-32. doi: 10.1038/eye.2012.34. Epub 2012 Mar 9. |
| D003240 | Connective Tissue Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D012871 | Skin Diseases |
| D005153 | Facial Neoplasms |
| D006258 | Head and Neck Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D005134 | Eye Neoplasms |