Pilot trial of remote monitoring to prevent malnutrition after hepatopancreatobiliary surgery

Abstract

Background Patients undergoing hepatopancreatobiliary (HPB) surgery, such patients with pancreatic, periampullary, and liver cancer, are at high risk for malnutrition. Malnutrition increases surgical complications and reduces overall survival. Despite its severity, there are limited interventions addressing malnutrition after HPB surgery. The aim of this pilot trial was to examine feasibility, acceptability, usability, and preliminary efficacy of a remote nutrition monitoring intervention after HPB surgery. Methods Participants received tailored nutritional counseling before and after surgery at 2 and 4 weeks after hospital discharge. Participants also recorded nutritional intake daily for 30 days, and these data were reviewed remotely by registered dietitians before nutritional counseling visits. Descriptive statistics were used to describe study outcomes. Results All 26 patients approached to participate consented to the trial before HPB surgery. Seven were excluded after consent for failing to meet eligibility criteria (e.g., did not receive surgery). Nineteen participants (52.6% female, median age = 65 years) remained eligible for remote monitoring post-surgery. Nineteen used the mobile app food diary, 79% of participants recorded food intake for greater than 80% of study days, 95% met with the dietitian for all visits, and 89% were highly satisfied with the intervention. Among participants with complete data, the average percent caloric goal obtained was 82.4% (IQR: 21.7). Conclusions This intervention was feasible and acceptable to patients undergoing HPB surgery. Preliminary efficacy data showed most participants were able to meet calorie intake goals. Future studies should examine intervention efficacy in a larger, randomized controlled trial. Trial registration Clinicaltrials.gov. Registered 16 September 2019, https://clinicaltrials.gov/ct2/show/NCT04091165.

Mobile applications in gastrointestinal surgery: a systematic review

“…The already available "MyPlate" app monitored postoperative dietary intake and was used by the dietitian to guide patients during counseling visits. Caloric goals were achieved by 82.4% of the patients [28].…”

“…Two apps monitored patients after undergoing hepatopancreatobiliary surgery and both had a high reporting adherence [25][26][27][28]. The "Interaktor" app was evaluated in a cohort, in which patients using the app reported significantly less symptoms and higher self-care activity rates compared to a historical control group [25][26][27].…”

Application of the theoretical framework of acceptability in a surgical setting: Theoretical and methodological insights

“…Some reports did not provide a definition or report how acceptability was measured (Bazzurini et al, 2022; James et al, 2021). Some studies concluded that the intervention was acceptable; however, on review of reported methods and results, references are made to ‘satisfaction’ which is arguably a different construct (Allenson et al, 2021; Quesada et al, 2022). These inconsistencies in the published literature demonstrate why consistent use of a definition, such as that proposed by Sekhon et al (2017) would be preferable and important.…”