Integration of a patient-orientated eHealth intervention in the setting of an established enhanced recovery after surgery program can reduce complications and length of stay: an observational study.

Abstract

Background: Enhanced recovery after surgery (ERAS) significantly improves outcomes for colorectal surgery, but in publicly funded health services with resource constraints, some targets can be difficult to fully implement. eHealth interventions are increasingly used in surgery to improve outcomes. In 2020, we developed eHealth content to optimise prehabilitation, the delivery of an ERAS program, and postoperative care in a tertiary New Zealand hospital. Our objective was to summarise the clinical outcomes of implementing a patient-orientated eHealth intervention for patients undergoing elective colorectal surgery for neoplasia.

Methods: We conducted a retrospective analysis of clinical outcomes with propensity score matching for patients undergoing elective colorectal resection for neoplastic disease between January 2020 and May 2024. Those using eHealth were compared to patients receiving standard care. Demographic and clinical data were extracted from the Otago Clinical Audit (OCA) database and from the eHealth platform. Complications, length of hospital stay (LOS), and readmission were compared using intention-to-treat (ITT) and per-protocol (PP) analyses.

Results: We identified 333 patients; 102 using eHealth and 231 receiving standard care. For matched ITT analysis, 102 patients from the standard care group were included. The eHealth group had a significantly shorter LOS [median of 5 vs. 6 days; relative risk (RR) =0.79; 95% confidence interval (CI): 0.71, 0.88; P<0.001] and fewer total complications [27 vs. 51; odds ratio (OR) =0.60; 95% CI: 0.30, 1.22; P=0.03]. Readmissions were not significantly different between groups. The eHealth platform was well-liked, with 72% of interactions rated as "very helpful".

Conclusions: Patient support through eHealth, with a focus on prehabilitation as well as postoperative recovery, can be used to effectively supplement ERAS pathways and improve clinical outcomes.