Currently submitted to: JMIR Perioperative Medicine
Date Submitted: Sep 19, 2019
Open Peer Review Period: Sep 19, 2019 - Nov 14, 2019
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Is perioperative tablet-based telemonitoring after abdominal wall hernia surgery feasible?
The economic burden of general surgical procedures is a major contributor to health costs all over the world. To reduce these costs and to enhance patient comfort, more and more procedures are transferred to a daycase setting, already e.g. hernias of the abdominal wall are repaired without keeping the patient overnight in a lot of countries. In the future, it is very likely that more complex procedures are considered to be safe to be carried out this way too. Up to now, we cannot offer our patients any intensified monitoring, once they have left the hospital. Tablet-based telemonitoring seems to be a promising way to change this situation.
The rationale for this study was to evaluate the feasibility of monitoring postoperative activity with a telemonitoring device after minor surgery of the abdominal wall.
Patients aged 18 and older, scheduled for elective surgical repair of abdominal wall hernias were equipped with a telemonitoring system including a tablet, a pulse-oximeter and an actimeter for a monitoring phase of one week before and five weeks after surgery. The primary objective was the feasibility of monitoring postoperative activity, secondary objectives were monitoring of pain and the impact of wound photographs for surveillance and early detection of surgical site infections (SSI).
We enrolled 16 patients (5 (31.3%) female, 11 (68.8%) male) with an age of mean±SD (Standard Deviation) 48.75 ± 16.28 between October 2017 and September 2018 in our center. Regarding our primary objective, we were able to gather information relating to the patient activity levels in all patients, except one. This resulted in a response rate of 75 percent in the preoperative week, with declining rates over the follow-up period. The gathered steps per week showed broad variations over the study period with e.g. in the preoperative week mean±SD 27951.00 ± 21036.56 steps, mean±SD 1523.17 ± 9345.58 in the 1st postoperative week and mean±SD 21019 ± 15865.21 steps in the 5th postoperative week. Regarding the secondary objectives, the maximum VAS was mean±SD 4,24 ± 1,81 with a duration of transferred VAS-data of mean±SD 14,19 ± 8,67 days postoperatively. In the first week after the operation, VAS-data was transferred completely on 1 to 6 days, but the rate continuously decreased over the following four weeks, resulting in no data transmission at all in 62,5 percent of the cases in the 5th week. There occurred no SSI during the follow-up period.
Our study showed, in principle, the feasibility of a tablet-based follow-up after repair of small hernias of the abdominal wall. Further studies should target to optimize technical issues and focus on general surgical procedures with a higher potential for postoperative complications to evaluate a possible reduction of their impact due to earlier recognition. Moreover, smaller gadgets and mobile phones could be utilized. Clinical Trial: Nil
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