Protocol for project recovery after cardiac surgery: a single-center cohort study leveraging digital platform to characterise longitudinal patient-reported postoperative recovery patterns

Abstract

IntroductionImproving postoperative patient recovery after cardiac surgery is a priority, but our current understanding of individual variations in recovery and factors associated with poor recovery is limited. We are using a health-information exchange platform to collect patient-reported outcome measures (PROMs) and wearable device data to phenotype recovery patterns in the 30-day period after cardiac surgery hospital discharge, to identify factors associated with these phenotypes and to investigate phenotype associations with clinical outcomes.Methods and analysisWe designed a prospective cohort study to enrol 200 patients undergoing valve, coronary artery bypass graft or aortic surgery at a tertiary centre in the USA. We are enrolling patients postoperatively after the intensive care unit discharge and delivering electronic surveys directly to patients every 3 days for 30 days after hospital discharge. We will conduct medical record reviews to collect patient demographics, comorbidity, operative details and hospital course using the Society of Thoracic Surgeons data definitions. We will use phone interview and medical record review data for adjudication of survival, readmission and complications. We will apply group-based trajectory modelling to the time-series PROM and device data to classify patients into distinct categories of recovery trajectories. We will evaluate whether certain recovery pattern predicts death or hospital readmissions, as well as whether clinical factors predict a patient having poor recovery trajectories. We will evaluate whether early recovery patterns predict the overall trajectory at the patient-level.Ethics and disseminationThe Yale Institutional Review Board approved this study. Following the description of the study procedure, we obtain written informed consent from all study participants. The consent form states that all personal information, survey response and any medical records are confidential, will not be shared and are stored in an encrypted database. We plan to publish our study findings in peer-reviewed journals.

Trajectories of Pain After Cardiac Surgery: Implications for Measurement, Reporting, and Individualized Treatment

“…Details of the protocol have been published. 7 The cardiac surgery service did not have a formalized Enhanced Recovery After Surgery pathway at the time of the study. Pain regimens were individualized to the patients’ needs during the hospitalization and at the time of discharge.…”

“…Quality of Recovery, a 24-item questionnaire assessing postoperative recovery 8 – 10 adapted from the original QoR-40, 11 was emailed every 3 days for 30 days. The questionnaire item for pain read “During the last 24 hours, I have been having pain in the surgical wound,” with possible responses ranging from 0 to 10 with 0 corresponding to “none of the time” and 10 corresponding to “all of the time.” Variables describing patient characteristics were prespecified in the protocol article 7 and were collected via the institutional Society of Thoracic Surgeon’s Adult Cardiac Surgery Database using the data version 2.91 definitions. Prescription of opioid medication at the time of hospital discharge was collected via chart review and standardized to morphine milligram equivalents.…”

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

“…Details of the protocol have been published. 7 The cardiac surgery service did not have a formalized Enhanced Recovery After Surgery (ERAS) pathway at the time of the study. Pain regimens were individualized to the patients' needs during the hospitalization and at discharge.…”

“…Other domains of recovery assessed were: sleep, ADLs, nausea, feeling of depression, anxiety, feeling rested, feeling restless, ability to enjoy food, ability to make a decision quickly, being able to remember things, and patient perception of overall recovery (scored 0-100%, with 0% being not recovered at all and 100% being fully recovered). Patient characteristics, intraoperative, and postoperative variables were prespeci ed 7 and collected via the institutional Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database using the data version 2.91 de nitions. 12 Digital platform characteristics A patient-speci c survey account was during enrollment using the patient's email address.…”

“…We conducted a study to evaluate the feasibility of using a digital platform to collect data, aiming to include diverse patients by simplifying enrollment and automating data collection. 7 We report on characterization of postoperative recovery after cardiac surgery in multiple key recovery domains using frequent measurement of PROM. We aimed to understand patient factors associated with the trajectory of the patients' perception of overall recovery in the rst 30 days after cardiac surgery.…”