Background: Emergency department (ED) visits and readmissions after thoracic surgery are a major health care problem. We hypothesized that the addition of a novel post discharge mobile app specific to thoracic surgery to an existing home care program would reduce ED visits and readmissions compared to a home care program alone.
Methods:We conducted a prospective cohort study of patients undergoing major lung resection for malignant disease between November 2016 and May 2018. Patients received either home care alone (control group) or home care plus a patientinput mobile app (inter vention group). Primary outcomes were 30day readmission and ED visit rates. Secondary outcomes included reasons for ED visits and readmissions, perioperative complications, 30day mortality, anxiety (assessed with the Generalized Anxiety Disorder7 Scale [GAD7]) and apprelated adverse events. We compared outcomes between the 2 groups, analyzing the data on an intentiontotreat basis.Results: Despite the greater number of open surgery and anatomic resections in the inter vention cohort, patients in that group were less likely than those in the control group to visit the ED within 30 days of discharge (24.0% v. 38.8%, p = 0.02). Thirtyday readmission rates were similar between the intervention and control groups (10.1% v. 12.2%, p = 0.6). In a subset of patients, there was no difference between the 2 groups in the proportion of patients with a GAD7 score of 0 (control group 79.8%, intervention group 79.5%, p = NS), which indicated a similar absence of postdischarge anxiety and depression symptoms in the 2 cohorts.
Conclusion:The addition of a mobile app to a home care program after thoracic surgery was associated with a reduced frequency of ED visits, in spite of the higher proportions of thoracotomies and anatomic resections in the app cohort. More studies are needed to eval u ate the full effect of this new, emerging technology.