Characterization of multi-domain postoperative recovery trajectories after cardiac surgery using a digital platform

Abstract

Understanding postoperative recovery is critical for guiding efforts to improve post-acute phase care. How recovery evolves during the first 30 days after cardiac surgery is not well-understood. A digital platform may enable granular quantification of recovery by frequently capturing patient-reported outcome measures (PROM) that can be clinically implemented to support recovery. We conduct a prospective cohort study using a digital platform to measure recovery after cardiac surgery using a PROM sent every 3 days for 30 days after surgery to characterize recovery in multiple domains (e.g., pain, sleep, activities of daily living, anxiety) and to identify factors related to the patient’s perception of overall recovery. We enroll patients who underwent cardiac surgery at a tertiary center between January 2019 and March 2020 and automatically deliver PROMs and reminders electronically. Of the 10 surveys delivered per patient, 8 (IQR 6–10) are completed. Patients who experienced postoperative complications more commonly belong to the worst overall recovery trajectory. Of the 12 domains modeled, only the worst anxiety trajectory is associated with the worse overall recovery trajectory membership, suggesting that even when patients struggle in the recovery of other domains, the patient may still feel progress in their recovery. We demonstrate that using a digital platform, automated PROM data collection, and characterization of multi-domain recovery trajectories is feasible and likely implementable in clinical practice. Overall recovery may be impacted by complications, while slow progress in constituent domains may still allow for the perception of overall recovery progression.

The digital transformation of surgery

“…There is emerging evidence that this form of data capture can potentially reduce complication rates 17 . In our collection, Mori et al use a digital health platform to better understand the nuances of post operative recovery in the home for cardiac surgery patients, far beyond just clinical events captured during postoperative ED visits or clinic visits 18 .…”

Remote Symptom Monitoring With Ecological Momentary Computerized Adaptive Testing: Pilot Cohort Study of a Platform for Frequent, Low-Burden, and Personalized Patient-Reported Outcome Measures

“…This infrequent cross-sectional sampling may fail to capture temporal fluctuations in symptom severity and introduce recall bias when patients are asked to remember how their health has been over a period of time. A solution to this is ecological momentary assessment (EMA) [18][19][20]. In EMA, patients complete serial PROM assessments in their natural (ecological) surroundings to report on their health state at the time of the assessment (momentarily).…”

Mobile Health Supported Multi-Domain Recovery Trajectories After Major Arthroplasty or Spine Surgery: A Feasibility Study

“…With an increasing number of these procedures being performed in older patients with multiple associated physical and psycho-social comorbidities, creating a roadmap of multi-domain postoperative recovery trajectories is important from both a patient and provider perspective. (3) Several studies have demonstrated that postoperative recovery is not uniform, with patients following multiple, different recovery pathways. (4,5) Predicting the probable recovery trajectory prior to surgery provides an opportunity for patient-centric postoperative management and early identi cation of deviations from these recovery trajectories.…”