Personalized Digital, Multilevel Program for Preparation and Early Recovery After Urologic Surgery: A Prospective, Multicenter, Pre- and Postintervention Trial.

Abstract

Background and objective: Electronic health can help improve perioperative outcomes and overcome organizational constraints related to human resources and health care-related costs. This study assesses the impact of implementing a digital smartphone app pathway with pre-/rehabilitation programs, checklists, and electronic patient-reported outcomes, on perioperative outcomes following urologic surgery.

Methods: In this prospective, multicenter, pre- and postintervention trial, we evaluated the impact of an app-based digital pathway. The primary endpoint was the rate of postoperative complications. The secondary endpoints were hospital stay, readmission and same-day discharge rates, number of days out of hospital, prolonged care at discharge, unplanned visits, and patient satisfaction. All endpoints were collected within 3 mo after surgery.

Key findings and limitations: Overall, 415 consecutive patients were included in the analysis: 208 before and 207 after the digital program implementation. Overall complications were lower in the intervention group (15% vs 28.4%; p < 0.001), as well as the major complications (1.9% vs 5.8%; p = 0.048). A reduction was also noticed in unplanned visits (1.9% vs 12.5%; p < 0.001) and readmission (5.3% vs 10.6%; p = 0.048). The need for prolonged care after discharge was reduced (13% vs 26.9%; p < 0.001) in the intervention group. The median patient satisfaction was 8/10 (5-9) before and 9/10 (9-10) after implementing the app pathway (p < 0.001).

Conclusions and clinical implications: The implementation of a digital pathway with pre-/rehabilitation, and checklists, was associated with better postoperative outcomes, faster recovery, and improved patient satisfaction.