The Potential Role of Advanced Practice Providers in Minimally Invasive Gynecologic Surgery

Background: Surgical practices thrive on a streamlined system of patient care from the pre-operative evaluation to the post-operative visit. In busy referral practice for minimally invasive gynecologic surgery (MIGS), a considerable amount of time may be spent with post-operative care of patients, whether that be due to comorbid medical conditions or complications from surgery. Utilization of Advanced Practice Providers (APP’s) may relieve the scheduling burden of practicing MIGS subspecialists. The objective of this study is to investigate the proportion of time spent for post-operative care of gynecologic surgical patients and explore potential solutions for women with gynecologic surgical needs to have greater access to care. Methods: This is a retrospective chart review conducted at a university-affiliated community hospital from June 2021 to January 2024. All patients under the care of a MIGS subspecialist within an urban tertiary care network were included in this study. The primary outcome is the number of post- operative appointments. The secondary outcomes include: the average number of post-operative appointments per patient, the primary diagnosis for patients requiring more than two post-operative appointments, the average number of pre-operative appointments per patient, and the number of interim imaging studies obtained during pre-operative evaluation per patient. Results: At our institution specific MIGS fellowship, 103.2 post-operative visits are held each year. Of these, patients on average will have 0.95 post-operative appointments. Of those patients with more than 2 post- operative appointments, the majority are due to continued surveillance, granulation tissue and vaginal bleeding. The average number of pre- operative visits per surgical consultation are 1.18 appointments. Of these, 17.7% of patients may expect to receive additional imaging, and of those, 54.1% for ultrasounds, 19.6% for computerized tomography (CT) scans, and 44.2% for magnetic resonance imaging (MRI) scans. Conclusions: The majority of patients operated on in a MIGS subspecialist practice have 1 routine post-operative care visits during their recovery course. The time necessary for 2 routine postoperative care visits equates to a new surgical consultation visit for a typical surgical consultative schedule. When averaged over the course of a year, 51 additional surgical consults may be seen that add additional access to care for women requiring surgery. Most postoperative visits were routine without complications, and this may be cared for by an experienced midlevel provider. In addition, a midlevel provider could assist in reviewing charts prior to consultation to ensure that the proper imaging has been obtained. This would not only be beneficial to the practice, but can remove barriers to care for the patient, allowing them to receive the care faster and with less appointments.