Perioperative Tablet-Based Telemonitoring After Abdominal Wall Hernia Surgery: Pilot Prospective Observational Cohort Study

Abstract

Background Hernia repairs account for millions of general surgical procedures performed each year worldwide, with a notable shift to outpatient settings over the last decades. As technical possibilities such as smartphones, tablets, and different kinds of probes are becoming more and more available, such systems have been evaluated for applications in various clinical settings. However, there have been few studies conducted in the surgical field, especially in general surgery. Objective We aimed to assess the feasibility of a tablet-based follow up to monitor activity levels after repair of abdominal wall hernias and to evaluate a possible reduction of adverse events by their earlier recognition. Methods Patients scheduled for elective surgical repair of minor abdominal wall hernias (eg, inguinal, umbilical, or trocar hernias) were equipped with a telemonitoring system, including a tablet, pulse oximeter, and actimeter, for a monitoring phase of 7 days before and 30 days after surgery. Descriptive statistical analyses were performed. Results We enrolled 16 patients with a mean overall age of 48.75 (SD 16.27) years. Preoperative activity levels were reached on postoperative day 12 with a median of 2242 (IQR 0-4578) steps after plunging on the day of surgery. The median proportion of available activity measurements over the entire study period of 38 days was 69% (IQR 56%-81%). We observed a gradual decrease in the proportion of available data for all parameters during the postoperative course. Six out of ten patients (60%) regained preoperative activity levels within 3 weeks after surgery. Overall, patients rated the usability of the system as relatively easy. Conclusions Tablet-based follow up is feasible after surgical repair of minor abdominal wall hernias, with good adherence rates during the first couple of weeks after surgery. Thus, such a system could be a useful tool to supplement or even replace traditional outpatient follow up in selected general surgical patients.

Mobile devices and wearable technology for measuring patient outcomes after surgery: a systematic review

“…Our review resulted in 324 full-text articles assessed for eligibility after initially screening 6969, with 44 articles (Fig. 1 ) ultimately included in this review 9 , 23 , 25 , 32 – 72 . Tables 1 and 2 provide descriptions of each study, recruiting 3890 patients in total across ten randomised controlled trials 9 , 32 – 40 , 17 prospective studies 25 , 42 – 54 , 71 and 17 pilot or feasibility studies 23 , 56 – 70 , 72 .…”

“…More than half of the studies were conducted in the United States ( n = 24; 1556 patients) 23 , 32 , 33 , 35 , 36 , 39 – 42 , 44 – 50 , 52 , 56 , 59 – 61 , 65 – 67 , with only one originating from a low- or middle-income setting 34 . Orthopaedic procedures were represented in a quarter of studies ( n = 10; 611 patients) 25 , 33 , 34 , 38 , 46 , 52 , 57 , 58 , 63 , 64 , with interventions taking place predominantly within the first 30 postoperative days 9 , 23 , 34 , 36 , 39 , 42 – 52 , 54 – 62 , 65 – 69 , 72 . Real-time data collection and autonomous delivery to clinicians for immediate review occurred in 31 studies 9 , 23 , 32 , 34 , 36 , 37 , 39 , 40 , 44 – 48 , 50 – 56 , 58 , 60 – 63 , 65 – 69 , 71 .…”

“…Accelerometer-based devices were the most commonly represented wearable device, measuring postoperative patient physical activity or intensity ( n = 14) via FitBit 25 , 43 , 49 , 52 , 61 , 72 smartwatch 42 , 65 , 66 or other devices 37 , 56 , 59 , 64 , 71 . Eight studies required the synchronisation of wearable devices to a mobile phone, together with manual download by a clinician on study completion, to allow data analysis 25 , 42 , 43 , 49 , 57 , 59 , 64 , 72 . Studies using wearables for continuous patient monitoring were less common, with only three studies reporting the use of automated data feeds for real-time clinical analytics and feedback 49 , 54 , 66 .…”

“…The majority of studies reported postoperative recovery as their main outcome (Table 4 ) 9 , 25 , 33 , 34 , 37 , 38 , 41 – 43 , 52 , 54 , 56 , 59 , 61 , 64 – 67 , 72 . Additional primary outcomes included the impact of DHI on pain management 33 , 34 , 44 , 46 , postoperative complications 50 , 51 , 58 , 60 , 68 , symptom monitoring 36 , 40 , surgical site infection 35 , 47 , 55 , 62 , 69 , 70 and hospital resource use 23 , 35 , 39 , 45 , 63 .…”

“…Differences in study methodology and outcome definitions limit conclusions on the effectiveness of DHI across each outcome. However, DHI demonstrated a strong ability to track postoperative analgesic requirements 33 , 34 , 44 , 46 and patient recovery 9 , 25 , 33 , 34 , 37 , 38 , 41 – 43 , 52 , 54 , 56 , 59 , 61 , 64 – 67 , 72 while consistently reducing hospital resource use in the postoperative period 39 , 45 , 63 , 70 . The capture of longer-term outcomes were also possible beyond 30 days, particularly for orthopaedic procedures 25 , 34 , 38 , 63 , 64 and to monitor weight loss 32 , 53 .…”