Evaluation of remote digital postoperative wound monitoring in routine surgical practice

Abstract

Remote digital postoperative wound monitoring provides an opportunity to strengthen postoperative community care and minimise the burden of surgical-site infection (SSI). This study aimed to pilot a remote digital postoperative wound monitoring service and evaluate the readiness for implementation in routine clinical practice. This was a single-arm pilot implementational study of remote digital postoperative wound monitoring across two tertiary care hospitals in the UK (IDEAL stage 2b, clinicaltrials.gov: NCT05069103). Adults undergoing abdominal surgery were recruited and received a smartphone-delivered wound assessment tool for 30-days postoperatively. Patients received 30-day postoperative follow-up, including the Telehealth Usability Questionnaire (TUQ). A thematic mixed-methods approach was used, according to the WHO framework for monitoring and evaluating digital health interventions. 200 patients were enroled, of whom 115 (57.5%) underwent emergency surgical procedures. Overall, the 30-day SSI rate was 16.5% (n = 33/200), with 72.7% (n = 24) diagnosed post-discharge. Usage of the intervention was 83.0% (n = 166/200), with subsequently 74.1% (n = 123/166) TUQ completion. There were no issues reported with feasibility of the technology, with the reliability (3.87, 95% CI: 3.73-4.00) and quality of the interface rated highly (4.18, 95%: 4.06-4.30). Patient acceptance was similarly high with regards to ease of use (4.51, 95% CI: 4.41-4.62), satisfaction (4.27, 95% CI: 4.13-4.41), and usefulness (4.07, 95% CI: 3.92-4.23). Despite the desire for more frequent and personalised interactions, the majority viewed the intervention as providing meaningful benefit over routine postoperative care. Remote digital postoperative wound monitoring successfully demonstrated readiness for implementation with regards to the technology, usability, and healthcare process improvement.

Fig. 1. INROADE patient flow diagram.

Depicts the patient flow for the INROADE study.

Fig. 2. Patient postoperative events, including responses to the online form, discharge from hospital, and SSI diagnoses.

Depicts the time-to-event (days) postoperatively for responses to the online form, discharge from hospital, and SSI diagnoses. This is shown for (A) All patients (B) Patients who were diagnosed with SSI within 30-days. Vertical lines represent median postoperative day of event.

Fig. 3. Patient rating of remote surgical wound assessment according to domains of the WHO Evaluation framework.

Depicts the mean agreement (95% confidence interval) and individual responses (points) to the Telehealth Usability Questionnaire (TUQ). This is reported according the WHO Evaluation framework domains through: A Questions on functionality, grouped by domain; B Questions summarised by domain on patient acceptance; C Questions on process improvement, grouped by domain.