The crystal clarity that smartphones can now take has been given another innovative use: monitoring patients who have undergone emergency abdominal surgery for surgical site infections (SSI) and allowing doctors to monitor them in the postoperative period diagnose earlier before they turn into a much bigger problem.
“Postoperative care has changed a lot since the COVID-19 pandemic began,” noted Kenneth McLean, MBChB, University of Edinburgh, Scotland, in a statement.
“Patients and staff have become accustomed to remote consultations, and we have shown that we can effectively and safely monitor post-operative wounds while patients recover at home – this is likely to become the new normal,” he added.
“Recovery can be a scary time for everyone, and these approaches provide reassurance,” added senior author Ewen Harrison, PhD, professor of surgery and data science at the University of Edinburgh, Scotland, in the same statement.
“We hope that early detection of wound problems can lead to treatments that limit complications,” he added.
The study was published online in npj Digital Medicine on November 18, 2021.
TWIST trial version
A total of 492 patients were enrolled in the TWIST study, most of whom underwent major surgical procedures, nearly three-quarters of which were performed laparoscopically. Approximately 223 patients were assigned to the smartphone intervention, while the remaining 269 patients were assigned to routine care. Patients in the smartphone group were contacted on days 3, 7, and 15 postoperatively and directed to an online site asking about their wound and the symptoms they were experiencing.
If they were symptomatic, they were then asked to take a photo of their wound and upload it to a secure website where a member of the surgical team would review the photos along with the patient’s reactions to signs of wound infection. Patients were observed 30 days after surgery to document whether they were later diagnosed with SSI.
Routine patients were simply contacted 30 days after surgery to see if they were diagnosed with infection or not. “Overall, 8.3% developed … and 7.4% in the routine care arm (P = 0.513).
However, the mean time to diagnosis of SSI – the primary endpoint of the study – was numerically shorter at 9.3 days in the smartphone group versus 11.8 days in the routine care group, although this difference was also not statistically significant. On the other hand, a post hoc analysis showed that patients who received a smartphone were almost four times more likely to get SSI in the first 7 postoperative days, with an odds ratio (OR) of 3.7 (95% confidence interval). ). [CI], 1.02-13.51; P = .043) compared to those assigned to routine care.
“These surgical wound infections usually worsen over time and, if left untreated, can spread into the bloodstream or deeper into the abdomen,” McLean said in an email to Medscape Medical News. “If we can diagnose these infections before they develop, we can potentially avoid these more serious complications and the need to re-admit them.” as the authors point out.
In fact, more than a third of patients diagnosed with SSI within the smartphone group had used the tool 48 hours prior to diagnosis – five were diagnosed on the same day – and all infections identified were based on patient reports of symptoms. “The inclusion of wound images offered a significant improvement in specificity from 84.4% (95% CI, 80.5-88.3%) to 93.6% (95% CI, 90.9-96.2%)” the researchers add.
The researchers also compared health service utilization between the two treatment groups. Overall, 14.3% of those who used a smartphone contacted a health service – either community or hospital – about their wound. This compared to 22.3% of the patients in the routine care group. Patients in the smartphone group also had a 43% lower rate of outpatient care services with an OR of 0.57 (95% CI, 0.34-0.94; P = 0.577), although their need for hospital emergency services was similar to that required was from routine patients.
And when comparing the 30-day patient experiences, the participants in the smartphone group reported significantly more positive experiences on all measures assessed, including access to care, easy access to advice and the quality of advice.
Some haven’t used the tool
The authors acknowledge that around a third of those assigned to the smartphone assessment tool have not used the tool at all. However, as McLean pointed out, there will always be a proportion of patients who are less likely to use a service if they feel it is not needed – their wound, for example, is healing well – so why bother? “It is reassuring,” he added, “that there was no evidence that elderly patients with smartphones, for example, use the tool less often,” he said.
The authors also pointed out that there are broader applications for the use of smartphones in healthcare. For example, the remote follow-up approach could be extended to other potential post-operative complications. It could also be used to monitor chronic wounds like diabetic ulcers or other chronic conditions like asthma or chronic obstructive pulmonary disease.
“Delays in access to adequate emergency medical care and unnecessary visits to the doctor can harm patients and add burdens to health services,” said McLean.
“With improved access to advice, patients are more likely to get the right treatment at the right time, and work is ongoing on how to tailor it to their needs [care] as accessible and inclusive as possible, “he added.
Fast adoption
Josh Totty, MD, NIHR Clinical Lecturer in Plastic Surgery, Hull York Medical School, UK, was asked to comment on the results.
“The rapid adoption of healthcare technology, with powerful computers that the majority of the people have in their pockets, has made patients and clinicians safe and risk-free, increased productivity, and made patient access to their clinicians easier . “he told Medscape Medical News in an email.
As we move out of the pandemic, Totty added, “We are constantly looking for ways to improve care that are acceptable to patients,” he said.
“And this study shows that smartphones can help diagnose significant infections earlier in the disease process. In turn, earlier treatment may lead to better outcomes and, as a result, less morbidity, ”added Totty. He also said the study was both important and well designed, adding to a growing body of evidence suggesting smartphones play a critical role in patient access to health care.
And he emphasized: “We must now work to ensure that everyone, whether young or old, rich or poor, has access to this technology.”
Npj Digital Med. Published online on November 18, 2021. Full text
Totty and the study authors did not disclose any relevant financial relationships.
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