Martin Joseph Heslin1, Joe-Spencer Liles1, Paulina Moctezuma-Velázquez2. 1. Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham (UAB), Birmingham, AL, USA. 2. Nacional Institute of Medical Sciences and Nutrition Salvador Zubirán, Tlalpan, Mexico City, México.
Abstract
BACKGROUND: Surgical management of pheochromocytomas involves appropriate pre-operative alpha blockade. This process often results in multiple clinic visits, substantial delay in resection, and use of limited resources. We sought to evaluate the benefit of patient participation and doctor-patient telecommunication in pre-operative alpha blockade. METHODS: A "study group" of patients, retrospectively collected, with pheochromocytoma requiring alpha-blockade therapy, during their initial clinic visit were educated on the use of a sphygmomanometer and the accurate detection of orthostatic blood pressure (BP). Subsequently, orthostatic evaluation and dose escalation were conducted through e-mail correspondence between the patient and the surgeon on a biweekly basis. This group of patients was compared with an historical "control group" consisting of 14 patients, whose preoperative treatment was titrated during clinic visits. RESULTS: The two groups were similar in terms of operation performed (laparoscopic versus open), estimated blood loss, tumor size, and post-operative length of stay. Active patient participation in pre-operative alpha blockade therapy resulted in significantly fewer preoperative visits (mean 1.52 vs. 3.20 visits; P=0.02) and a significantly shorter time from initiation of blockade to resection (33 vs. 82 days; P=0.03). CONCLUSIONS: Titration of alpha blockade therapy through patient and surgeon e-mail correspondence is efficacious and saves limited resources and time. This process eliminates unnecessary travel time and expenses for the patient. Due to the benefits of telemedicine for pheochromocytoma preoperative care, our method should be implemented in the routine surgical care of pheochromocytomas.
BACKGROUND: Surgical management of pheochromocytomas involves appropriate pre-operative alpha blockade. This process often results in multiple clinic visits, substantial delay in resection, and use of limited resources. We sought to evaluate the benefit of patient participation and doctor-patient telecommunication in pre-operative alpha blockade. METHODS: A "study group" of patients, retrospectively collected, with pheochromocytoma requiring alpha-blockade therapy, during their initial clinic visit were educated on the use of a sphygmomanometer and the accurate detection of orthostatic blood pressure (BP). Subsequently, orthostatic evaluation and dose escalation were conducted through e-mail correspondence between the patient and the surgeon on a biweekly basis. This group of patients was compared with an historical "control group" consisting of 14 patients, whose preoperative treatment was titrated during clinic visits. RESULTS: The two groups were similar in terms of operation performed (laparoscopic versus open), estimated blood loss, tumor size, and post-operative length of stay. Active patient participation in pre-operative alpha blockade therapy resulted in significantly fewer preoperative visits (mean 1.52 vs. 3.20 visits; P=0.02) and a significantly shorter time from initiation of blockade to resection (33 vs. 82 days; P=0.03). CONCLUSIONS: Titration of alpha blockade therapy through patient and surgeon e-mail correspondence is efficacious and saves limited resources and time. This process eliminates unnecessary travel time and expenses for the patient. Due to the benefits of telemedicine for pheochromocytoma preoperative care, our method should be implemented in the routine surgical care of pheochromocytomas.
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