Mobile App OK for Postoperative Follow-up

Pam Harrison

March 23, 2017

Using a mobile app for follow-up care after breast reconstruction surgery reduces the need for in-person follow-up visits during the first 30 days without affecting complication rates or patient satisfaction, new research shows.

For the most part, morbidity and mortality rates after ambulatory surgery are very low; therefore, most follow-up visits are "perfunctory," the researchers write.

"Follow-up via a mobile app can be used to eliminate in-person follow-up visits during the first 30 days following ambulatory breast reconstruction surgery," the authors explain.

"Mobile app follow-up care is suitably targeted to low-risk postoperative ambulatory patients," they add.

John L. Semple, MD, from Women's College Hospital, University of Toronto, Ontario, Canada, and colleagues published their findings online March 22 in JAMA Surgery.

The researchers randomly assigned 65 women (mean age 47.7 years) to either the mobile app group or to the in-person follow-up care group. "The mobile app follow-up group had no planned in-person follow-up at 1 week and 4 weeks after the operation," the investigators note. Instead, they submitted photographs of their surgical site to the hospital, using the mobile app.

Patients in the mobile app group also used the app to submit reports documenting both pain and the quality of recovery. Surgeons involved in the study simply used a wireless device to access patient data and monitor their recovery. Patients in the in-person follow-up group attended a mean 1.64 in-person visits during the initial 30 days after surgery. This included three patients who felt the need to make an emergency department visit during the follow-up interval.

In contrast, women assigned to the mobile app made a mean of 0.66 in-person visits, or 0.40 times fewer in-person visits compared with the in-person follow-up group (P < .001). No patients in the mobile app group had to visit the emergency department during the same follow-up interval, and the difference between the mobile app group and the in-person group was maintained out to 3 months, as investigators note.

Both groups made virtually identical numbers of telephone calls to the healthcare team during the first 30 days after surgery, at a mean of 0.31 calls for the mobile app group and a mean of 0.30 calls for the in-person follow-up group.

In contrast, women in the mobile app group were significantly more likely to send emails during their follow-up care, at a mean of 0.65 emails compared with a mean of 0.15 emails for the in-person follow-up group (incidence rate ratio, 4.13; 95% confidence interval, 1.55 - 10.99; P = .005). The investigators note that the proportion of patients who received prior radiotherapy, as well as the distance between home and hospital, was unbalanced between the two groups.

Both of these baseline features could likely alter the need for follow-up care, the researchers explain. The potential for delayed wound healing in those who received radiotherapy could increase the need for care, and a greater distance between home and hospital might result in fewer in-person follow-up visits. After adjusting for these imbalances, the differences between the two groups remained robust, the authors write.

Patient satisfaction scores, as assessed by the 5-point Likert scale, did not differ between the two groups. However, 97% of patients in the mobile app group reported their care was convenient compared with 48% of patients in the in-person follow-up group. Complication rates were very low in both groups.

"[A] common criticism of telemedicine or virtual communication between patients and health care professionals is whether it truly replaces in-person care," the investigators point out.

"These are important findings given the current demands on the health care system and the push toward patient-centric care," they conclude.

Although patients liked the mobile app, the effect that the "virtual" follow-up approach had on the staff remains unknown, Tarik Sammour, PhD, from the University of Texas M.D. Anderson Cancer Center in Houston, and Andrew Hill, MD, from the University of Auckland in New Zealand, write in an invited commentary.

"The daily patient reporting of pain scores, the responses to recovery questionnaires, and the photographs (which presumably all needed review by health care staff) do provide a means of obtaining more frequent data points," they write. "[B]ut these data, as well as the more frequent electronic communication via email, may not have been an insignificant burden on the time and resources of the health care staff," the commentators add.

Dr Sammour and Dr Hill also postulate that the time allotted for follow-up care in the study was perhaps more than required for such a low-risk group. "Would a 10-minute telephone call at 1 or 2 weeks have sufficed for this patient group, with a contact number to report complications, for example?" they ask.

And what about extending the use of a mobile app after more complicated surgeries in higher-risk patients? "It is clear that this modality of patient follow-up is currently limited to patients undergoing low-risk surgery who are adept at using mobile devices such as smartphones, but nevertheless, the findings suggest that there is value to be gained by delegating postoperative follow-up to the remote telemedicine space," Dr Sammour and Dr Hill conclude.

Dr Semple reports holding shares in QoC Health Inc. The remaining authors and commentators have disclosed no relevant financial relationships.

JAMA Surg. Published online March 22, 2017. Article full text, Commentary full text

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