Postoperative monitoring with a mobile application after ambulatory lumbar discectomy: an effective tool for spine surgeons

Debono, Bertrand; Bousquet, Philippe; Sabatier, Pascal; Plas, J; Lescure, J; Hamel, Olivier

doi:10.1007/s00586-016-4680-4

Cited by 85 publications

(68 citation statements)

References 24 publications

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“…The use of e-health is very promising, allows for personalized 24-hour monitoring, and does not force postoperative problems onto the general practitioner or external emergency services. 6,14,27,31 The model we propose remains at an acceptable cost to our institution, which saves money by reducing the LOS. 8…”

Section: Implementation Of Erasmentioning

confidence: 99%

“…28 Regarding the early home followup, a nurse from the ERAS team was available 24 hours a day by phone or a dedicated mobile application (app). 6…”

Section: Postoperative Stepmentioning

confidence: 99%

“…35 Thanks to a synergistic vision of the health group and caregivers at our institution, 33 multidisciplinary work on the implementation of ERAS has been done at our institution since the end of 2013, and in the past we have reported on the application of these techniques in outpatient lumbar spine surgery. 6,8 We strongly assume that the transition to outpatient surgery (recently in Europe) follows exactly the same rules as those of ERAS. Following these first clinical trials, we report on our initial experience in applying an ERAS program to several degenerative spinal fusion procedures.…”

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confidence: 99%

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Benefits of Enhanced Recovery After Surgery for fusion in degenerative spine surgery: impact on outcome, length of stay, and patient satisfaction

Debono

Corniola

Pietton

et al. 2019

Neurosurgical Focus

Self Cite

108

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OBJECTIVEEnhanced Recovery After Surgery (ERAS) proposes a multimodal, evidence-based approach to perioperative care. Thanks to the improvement in care protocols and the fluidity of the patient pathway, the first goal of ERAS is the improvement of surgical outcomes and patient experience, with a final impact on a reduction in the hospital length of stay (LOS). The implementation of ERAS in spinal surgery is in the early stages. The authors report on their initial experience in applying an ERAS program to several degenerative spinal fusion procedures.METHODSThe authors selected two 2-year periods: the first from before any implementation of ERAS principles (pre-ERAS years 2012–2013) and the second corresponding to a period when the paradigm was applied widely (post-ERAS years 2016–2017). Patient groups in these periods were retrospectively compared according to three degenerative conditions requiring fusion: anterior cervical discectomy and fusion (ACDF), anterior lumbar interbody fusion (ALIF), and posterior lumbar fusion. Data were collected on patient demographics, operative and perioperative data, LOSs, 90-day readmissions, and morbidity. ERAS-trained nurses were involved to support patients at each pre-, intra-, and postoperative step with the help of a mobile application (app). A satisfaction survey was included in the app.RESULTSThe pre-ERAS group included 1563 patients (159 ALIF, 749 ACDF, and 655 posterior fusion), and the post-ERAS group included 1920 patients (202 ALIF, 612 ACDF, and 1106 posterior fusion). The mean LOS was significantly shorter in the post-ERAS group than in the pre-ERAS group for all three conditions. It was reduced from 6.06 ± 1.1 to 3.33 ± 0.8 days for the ALIF group (p < 0.001), from 3.08 ± 0.9 to 1.3 ± 0.7 days for the ACDF group (p < 0.001), and from 6.7 ± 4.8 to 4.8 ± 2.3 days for posterior fusion cases (p < 0.001). There was no significant difference in overall complications between the two periods for the ALIF (11.9% pre-ERAS vs 11.4% post-ERAS, p = 0.86) and ACDF (6.0% vs 8.2%, p = 0.12) cases, but they decreased significantly for lumbar fusions (14.8% vs 10.9%, p = 0.02). Regarding satisfaction with overall care among 808 available responses, 699 patients (86.5%) were satisfied or very satisfied, and regarding appreciation of the mobile e-health app in the perceived optimization of care management, 665 patients (82.3%) were satisfied or very satisfied.CONCLUSIONSThe introduction of the ERAS approach at the authors’ institution for spinal fusion for three studied conditions resulted in a significant decrease in LOS without causing increased postoperative complications. Patient satisfaction with overall management, upstream organization of hospitalization, and the use of e-health was high. According to the study results, which are consistent with those in other studies, the whole concept of ERAS (primarily reducing complications and pain, and then reducing LOS) seems applicable to spinal surgery.

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Section: Implementation Of Erasmentioning

confidence: 99%

“…28 Regarding the early home followup, a nurse from the ERAS team was available 24 hours a day by phone or a dedicated mobile application (app). 6…”

Section: Postoperative Stepmentioning

confidence: 99%

mentioning

confidence: 99%

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Benefits of Enhanced Recovery After Surgery for fusion in degenerative spine surgery: impact on outcome, length of stay, and patient satisfaction

Debono

Corniola

Pietton

et al. 2019

Neurosurgical Focus

Self Cite

108

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“…All studies but one were on the monitoring of activity level at home using mobile devices such as smartphones. (11)(12)(13) The one study that monitored bio signs at home was on 20 patients after liver transplants. (14) We present here the first feasibility results on post-op home monitoring of bio signs after primary hip or knee replacements.…”

Section: Resultsmentioning

confidence: 99%

Postoperative Home Monitoring After Joint Replacement: Feasibility Study (Preprint)

Yang¹,

Dervin²,

Madden³

et al. 2018

Preprint

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BACKGROUND We conducted a prospective observational study of patients undergoing elective primary hip or knee replacements to examine the feasibility of a postoperative home monitoring system as transitional care to support patients following their surgery in real time. OBJECTIVE The primary outcome was the mean percentage of successful wireless transmissions from home of blood pressure levels, heart rate, oxygen saturation levels, and pain scores until postoperative day 4 with a feasibility target of ≥90%. METHODS Patients with an expected length of stay ≤1 day, age 18-80 years, Revised Cardiac Risk Index ≤ class 2, and caretakers willing to assist at home were eligible. Patient satisfaction, as a secondary outcome, was also evaluated. Wireless monitoring equipment (remote patient monitoring, Telus Canada) was obtained and a multidisciplinary care team was formed. RESULTS We conducted the study after obtaining Research Ethics Board approval; 54 patients completed the study: 21 males, 33 females. In total, we evaluated 9 hips, 4 hip resurfacing, 26 total knees, and 15 hemi-knees. The mean transmission rate was 96.4% (SD 5.9%; 95% CI 94.8-98.0). The median response to “I would recommend the Remote Monitoring System program to future patients” was 4.5 (interquartile range 4-5), with 1 being “strongly disagree” and 5 “strongly agree.” At 30 days postop, there was no mortality or readmission. CONCLUSIONS This is an evolving new paradigm for postoperative care and the first feasibility study on monitoring biometrics after primary hip or knee replacement. Postoperative home monitoring combines current technology with real-time support by a multidisciplinary transitional care team after discharge, facilitating postsurgical care with successful wireless transmission of vitals. The postoperative home monitoring implementation is, therefore, generalizable to other surgical discharges from hospitals. CLINICALTRIAL ClinicalTrials.gov NCT02143232; https://clinicaltrials.gov/ct2/show/NCT02143232 (Archived by WebCite at http://www.webcitation.org/71ugAhhIk)

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“…Digital technology is transforming health care. Electronic health (eHealth) and mobile health (mHealth) technologies ( Textbox 1 ) facilitate self-management (eg, self-monitoring of weight [ 1 ], increase medication adherence [ 2 , 3 ], and promote diabetes self-management [ 4 ]), (tele-) communication (eg, in self-management of hypertension [ 5 ], ambulatory care for chronic diseases [ 6 ], and patient-doctor communication [ 7 ]), efficient data sharing (eg, using a personal health record (PHR) [ 8 ]), and remote monitoring (eg, remote pain assessment [ 9 , 10 ]). Although evidence on their efficacy remains limited in some sectors [ 11 , 12 ], more robust evidence is already available in others [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

A Cloud-Based Virtual Outpatient Clinic for Patient-Centered Care: Proof-of-Concept Study

et al. 2018

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BackgroundMost electronic health (eHealth) interventions offered to patients serve a single purpose and lack integration with other tools or systems. This is problematic because the majority of patients experience comorbidity and chronic disease, see multiple specialists, and therefore have different needs regarding access to patient data, communication with peers or providers, and self-monitoring of vital signs. A multicomponent digital health cloud service that integrates data sharing, collection, and communication could facilitate patient-centered care in combination with a hospital patient portal and care professionals.ObjectiveThis study aimed to assess the feasibility and functionality of a new cloud-based and multicomponent outpatient clinic, the “Virtual Outpatient Clinic” (VOC).MethodsThe VOC consists of 6 digital tools that facilitate self-monitoring (blood pressure, weight, and pain) and communication with peers and providers (chat and videoconferencing) connected to a cloud-based platform and the hospital patient portal to facilitate access to (self-collected) medical data. In this proof-of-concept study, 10 patients from both Departments of Internal Medicine and Dermatology (N=20) used all options of the VOC for 6 weeks. An eNurse offered support to participants during the study. We assessed the feasibility, usage statistics, content, adherence, and identified technical issues. Moreover, we conducted qualitative interviews with all participants by following a standard interview guide to identify user experiences, including barriers, facilitators, and potential effects.ResultsMost participants successfully used all options of the VOC and were positive about different tools and apps and the integral availability of their information. The adherence was 37% (7/19) for weight scale, 58% (11/19) for blood pressure monitor, and 70% (14/20) and 85% (17/20) for pain score and daily questions, respectively. The adherence for personal health record was 65% (13/20) and 60% (12/20) for the patient portal system. Qualitative data showed that performance and effort expectancy scored high among participants, indicating that using the VOC is convenient, easy, and time-saving.ConclusionsThe VOC is a promising integrated Web-based technology that combines self-management, data sharing, and communication between patients and professionals. The system can be personalized by connecting various numbers of components, which could make it a relevant tool for other patient groups. Before a system, such as the VOC, can be implemented in daily practice, prospective studies focused on evaluating outcomes, costs, and patient-centeredness are needed.

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Postoperative monitoring with a mobile application after ambulatory lumbar discectomy: an effective tool for spine surgeons

Abstract: Overall patient satisfaction was excellent. Mobile app provides an effective useful tool for outpatient spine surgery monitoring and minimizes the need for in-person visits for postoperative patients.

Cited by 85 publications

References 24 publications

Benefits of Enhanced Recovery After Surgery for fusion in degenerative spine surgery: impact on outcome, length of stay, and patient satisfaction

Benefits of Enhanced Recovery After Surgery for fusion in degenerative spine surgery: impact on outcome, length of stay, and patient satisfaction

Postoperative Home Monitoring After Joint Replacement: Feasibility Study (Preprint)

A Cloud-Based Virtual Outpatient Clinic for Patient-Centered Care: Proof-of-Concept Study

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