Grand Rounds

Post-Operative Care: Can an e-Health Program Pick up the Slack?

BACKGROUND AND PURPOSE:

A benefit of minimally invasive surgery includes decreased length of stay, but less time for health-care professionals to interact with patients post-operatively
Interactive e-health programme may bridge this gap and provide additional guidance and information to improve time to recovery
Van der Meij et al. (Lancet, 2018) assessed the efficacy of a personalized e-health-care programme on return to normal activities after surgery

Multicenter, single-blind, randomized controlled trial (RCT)
Participants
- Ages: 18-75 years
- Surgeries: Laparoscopic adnexal surgery for benign indications | Cholecystectomy | Inguinal hernia surgery
Participants were randomized into either
- Control group: Usual care and a placebo website containing standard recovery advice
- Intervention group: Perioperative, personalized, e-health-care programme
E-health-care programme design included
- Day-to-day feedback tailored to patient’s personal situation by an activity tracker
- E-consult function enabling chat with the provider
Primary outcome
- Time between surgery and return to normal activities
Secondary outcomes
- Multiple secondary findings such as physical function, social participation, full resumption of work activities etc. were also assessed

344 participants were enrolled
- 173 in the intervention and 171 in the control group
Median time until return to normal activities
- 21 days (95% CI, 17–25) in the intervention group
- 26 days (95% CI, 20–32) in the control group
  - Hazard ratio 1.38, 95% CI 1.09–1.73; p=0.007)
Complications did not differ between groups

A personalized e-health intervention can speed recovery time without increasing risk for complications
The authors suggest that an e-health programme “should be considered for implementation in standard perioperative care”

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