Feasibility and satisfaction with remote digital postoperative follow-up using a three-tiered alert system after bariatric surgery.

Abstract

Introduction: With the global prevalence of obesity steadily increasing, bariatric surgery has gained significance in managing this health challenge. Fast-track healthcare pathways have shown promise in improving outcomes and patient satisfaction for bariatric surgery. In this study, we aimed to evaluate the safety and feasibility of responsive remote digital postoperative follow-up using a smartphone application.

Materials and methods: Consecutive patients undergoing bariatric surgery at CHU Saint-Pierre University Hospital between September 2022 and October 2023 were prospectively enrolled. Patients were instructed to download and install the application on their smartphones, which prompted them with predetermined daily questions. Depending on their responses, alerts could be generated for review by medical staff A three-tiered alert system (orange, red, red+) was implemented to signify increasing significance. Comparisons between categorical variables were conducted using Fisher's exact test, while comparisons between continuous variables were assessed using the one-way Analysis of Variance (ANOVA) test for normally distributed data and the Mann-Whitney U test for non-normally distributed data.

Results: During the study period, a total of 1119 alerts were recorded from 104 patients, with 39.3% occurring within the first seven postoperative days. Patient alert profiles were significantly associated with postoperative outcomes, with worsening outcomes observed from basic orange alerts to red+ alerts. Patients with red+ alerts had nearly a threefold increase in postoperative morbidity rates, emergency department visits, and readmissions. No significant differences in weight loss outcomes were observed. Patient response adherence was 67.5%, while the overall satisfaction with the use of the application was 94%.

Conclusion: Remote follow-up via a mobile application holds promise for enhancing the management of bariatric surgery patients, complementing traditional practices. The implementation of a three-tiered alert system may help identify patients at risk of serious complications, potentially reducing unnecessary emergency department and hospital resource utilization.