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#Grand Rounds

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

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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

METHODS: 

  • 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  

RESULTS: 

  • 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 

CONCLUSION: 

  • 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”

Learn More – Primary Sources: 

Personalised perioperative care by e-health after intermediate-grade abdominal surgery: a multicentre, single-blind, randomised, placebo-controlled trial

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