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Post-ERAS internet-connected surveillance detects complications

Tue, 07/28/2020 - 17:49
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Internet-connected surveillance as part of a bariatric surgery enhanced recovery after surgery (ERAS) programme was safe and effective in detecting 100% of early complications and most patients were satisfied with their care, according to researchers from France. The findings were reported in the paper, ‘Connected Surveillance for Detection of Complications After Early Discharge from Bariatric Surgery’, was published in Obesity Surgery.

The authors noted that ERAS programmes are designed to improve multiple recovery parameters, reduce post-operative morbidity and length of hospital stay, and decrease costs, whilst maintaining the same safety, quality of aftercare and low readmission rate achieved by standard post-operative hospitalisation. Therefore, they carried out study in a French medical centre to evaluate an ERAS protocol combined with an ‘Internet-connected surveillance’ home follow-up to ascertain if it would result in the same level of safety as longer post-operative hospitalisation.

The researchers used a ‘cloud-based’ software as a service (SaaS) solution and has two modules:: a patient engagement module accessible to the patient as a native mobile application and a web application for all desktop and laptop computers and browsers. Patients were given the option of either surveillance method. The relevant healthcare professionals have access to a management application module to review the patient’s data and track his/her progress and health status.

Patients were discharged from hospital the day after surgery (if they met the discharge criteria) and were included in the ten-day follow-up study period (then included in surgical consultations at one, three and six months, and as needed), which was monitored 24h per day by 25 specially trained nurses. The surveillance included data collection (patient-reported outcomes) and an automatic alert system to highlight abnormal events. Patients were instructed to connect at least once a day to complete an online patient-oriented questionnaire (designed to capture clinical side effects of surgery i.e. fever, nausea, pain etc). reporting their current health status and possible complications. The daily clinical results were sent to the surgeon who could connect to the platform and review the details of all patients.

Outcomes

In total, 264 patients completed the internet-connected home monitoring ERAS programme. The mean age of patients was 40±10.4 years (20–66) and mean pre-operative BMI42.4±15.3 (36–54). Most patients were female (236 females, 45 males), 126 (47.70%) underwent one anastomosis gastric bypass and 138 (52.3%) underwent sleeve gastrectomy. Mean length of hospital stay (LOS) for all operative procedures was 1.38 days and 75.4% (199/264) were discharged on post-operative day one. The mobile phone application was used by 62.0% vs 38.0% who opted for the website.

Every complication sustained (100%) was detected by the connected surveillance protocol, with 22 (8.0%) unexpected complications (defined as unscheduled surgery consultations prior the one-month follow-up consultation) and included: abdominal pain and/or anxiety (41.0%), nausea (27.3%), wound infection/wound haematoma (23.0%) and colonic transit perturbation (9.0%). All were managed conservatively at home. Complications included three re-operations (one staple line bleed, one perigastric haematoma and one gastrocele). Six patients were readmitted for hospitalisation, four for non-surgery-related complications after investigation and two patients for complications managed with non-surgical treatment.

Patients were also asked to complete a satisfaction survey one month after surgery with 96.0% satisfied with the internet-based follow-up method. The survey also revealed that patients found the applications easy to use, felt safe at home and were reassured that the call helpline was always available to them and provided a sense of security throughout the ten-day programme.

“Instituting an ERAS programme requires a commitment to multidisciplinary team involvement,” the authors write. “Utilising a connected surveillance post-discharge protocol with a specialised nursing and surgeon team may provide the patient support required for proper management of emerging complications.”

To access this paper, please click here