Personalised perioperative care by e-health after intermediate-grade abdominal surgery: a multicentre, single-blind, randomised, placebo-controlled trial.

Abstract

BACKGROUND:

Instructing and guiding patients after surgery is essential for successful recovery. However, the time that health-care professionals can spend with their patients postoperatively has been reduced because of efficiency-driven, shortened hospital stays. We evaluated the effect of a personalised e-health-care programme on return to normal activities after surgery.

METHODS:

A multicentre, single-blind, randomised controlled trial was done at seven teaching hospitals in the Netherlands. Patients aged 18-75 years who were scheduled for laparoscopic cholecystectomy, inguinal hernia surgery, or laparoscopic adnexal surgery for a benign indication were recruited. An independent researcher randomly allocated participants to either the intervention or control group using computer-based randomisation lists, with stratification by sex, type of surgery, and hospital. Participants in the intervention group had access to a perioperative, personalised, e-health-care programme, which managed recovery expectations and provided postoperative guidance tailored to the patient. The control group received usual care and access to a placebo website containing standard general recovery advice. Participants were unaware of the study hypothesis and were asked to complete questionnaires at five timepoints during the 6-month period after surgery. The primary outcome was time between surgery and return to normal activities, measured using personalised patient-reported outcome measures. Intention-to-treat and per-protocol analyses were done. This trial is registered in the Netherlands National Trial Register, number NTR4699.

FINDINGS:

Between Aug 24, 2015, and Aug 12, 2016, 344 participants were enrolled and randomly allocated to either the intervention (n=173) or control (n=171) group. 14 participants (4%) were lost to follow-up, with 330 participants included in the primary outcome analysis. Median time until return to normal activities was 21 days (95% CI 17-25) in the intervention group and 26 days (20-32) in the control group (hazard ratio 1·38, 95% CI 1·09-1·73; p=0·007). Complications did not differ between groups.

INTERPRETATION:

A personalised e-health intervention after abdominal surgery speeds up the return to normal activities compared with usual care. Implementation of this e-health programme is recommended in patients undergoing intermediate-grade abdominal, gynaecological, or general surgical procedures.

FUNDING:

ZonMw.

• Authors: Eva van der Meij, Johannes R Anema, Wouter K G Leclercq, Marlies Y Bongers, Esther C J Consten, Steven E Schraffordt Koops, Peter M van de Ven, Caroline B Terwee, Johanna M van Dongen, Frederieke G Schaafsma, Wilhelmus J H J Meijerink, Hendrik J Bonjer, Judith A F Huirne
• Journal: Lancet (London, England) (Lancet) Vol. 392 Issue 10141 Pg. 51-59 (07 07 2018) ISSN: 1474-547X [Electronic] England
• PMID: 29937195 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2018 Elsevier Ltd. All rights reserved.

Topics

• Abdomen (surgery)
• Activities of Daily Living (classification)
• Adult
• Female
• Humans
• Internet
• Male
• Middle Aged
• Patient Education as Topic (methods)
• Perioperative Care (methods)
• Precision Medicine (methods)
• Single-Blind Method
• Surveys and Questionnaires
• Telemedicine (methods)