Electronic patient-reported symptom monitoring in patients recovering from ambulatory minimally invasive gynecologic surgery: A prospective pilot study

Gynecol Oncol. 2020 Oct;159(1):187-194. doi: 10.1016/j.ygyno.2020.07.004. Epub 2020 Jul 24.

Abstract

Objective: To evaluate the feasibility of an electronic symptom-tracking platform for patients recovering from ambulatory surgery.

Method: We assessed user response to an electronic system designed to self-report symptoms. Endpoints included compliance, postoperative symptoms, patient satisfaction. An 8-item symptom inventory (pain, nausea, vomiting, shortness of breath, fever, swelling, discharge, redness) was developed and made available on postoperative days (POD) 2-6. Responses exceeding defined thresholds of severity triggered alerts to healthcare providers. Symptoms, alerts, actions taken, urgent care center (UCC) visits, hospital admissions were tracked until POD 30. Patient satisfaction was evaluated on POD 7. A patient was defined as "responder" if at least 5/8 items on at least 3 PODs were completed. The assessment method was deemed successful if 64/100 patients responded.

Results: 97/102 patients were evaluable; 65 met "responder" criteria (67% responder rate; 95% CI 57-76%). 321 surveys were completed (median 4/patient), 248 (77%) in ≤2 min. Involving caregivers and allowing additional symptom-reporting improved the responder rate to 72% (95% CI 58-84%). Most commonly-reported moderate, severe, very severe symptoms were pain, nausea, swelling; 71% reported moderate to very severe pain on POD 2. Phone calls and adjustment of medications adequately addressed most symptoms. Two patients (2%) presented at UCC before, 6 (6%) after, POD 6; 1 (1%) was admitted. Most agreed or strongly agreed that electronic symptom-tracking was helpful, easy to use, and would recommend it to others.

Conclusion: Electronic symptom-tracking is feasible for patients undergoing ambulatory gynecologic cancer surgery. Symptom burden is high in the early postoperative period. Addressing patient-reported symptoms in a timely, automated manner may prevent severe downstream adverse events, reduce UCC visits and admission rates, and improve outcomes.

Keywords: Electronic patient-reported symptom monitoring; Minimally invasive surgery; Patient-reported outcomes.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aftercare / methods*
  • Aftercare / organization & administration
  • Ambulatory Surgical Procedures / adverse effects
  • Ambulatory Surgical Procedures / methods
  • Cancer Care Facilities / organization & administration
  • Feasibility Studies
  • Female
  • Genital Neoplasms, Female / surgery*
  • Gynecologic Surgical Procedures / adverse effects*
  • Gynecologic Surgical Procedures / methods
  • Humans
  • Internet-Based Intervention*
  • Middle Aged
  • Minimally Invasive Surgical Procedures / adverse effects
  • Minimally Invasive Surgical Procedures / methods
  • Outpatient Clinics, Hospital / organization & administration
  • Patient Readmission / statistics & numerical data
  • Patient Reported Outcome Measures
  • Patient Satisfaction / statistics & numerical data
  • Pilot Projects
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / etiology
  • Postoperative Complications / therapy
  • Prospective Studies
  • Quality of Life
  • Self Report / statistics & numerical data
  • Treatment Outcome