Patient self-reported pain and nausea via smartphone following daycare surgery, first year results: An observational cohort study
Authors: Thiel Bram , Blaauboer Jamey , Seesing Chiem , Radmanesh Jamshid , Koopman Seppe , Kalkman Cor , Godfried Marc 
Published: August 2023

Contact with the hospital is usually limited for patients after daycare surgery. Dedicated smartphone applications can improve communication and possibly enhance outcomes. The objective of this retrospective study was to evaluate patients’ self-reported pain and nausea and assess the success of routine implementation of a smartphone application for outcome reporting. During preoperative assessment, patients were instructed to download and activate the smartphone application to report pain, nausea and to be in contact with the hospital after discharge. Main outcome was the number of patients actively using the smartphone application and the incidence of pain and nausea on postoperative day 1 to 7. In total, 4952 patients were included in the study. A total of 592 (12%) participants downloaded the application, of whom 351 (7%) were active users. A total of 4360 (88%) participants refrained from downloading the application. 56% (2,769) were female, the median age was 46 (18-92), and 4286 (87%) were classified as 1 or 2 American Society of Anesthesiologists Physical Status (ASA). Postoperative pain was experienced by 174 (76%) of 229 active users on postoperative day (POD) 1 and decreased to 44 (44%) of 100 active users on POD7. Postoperative nausea was experienced by 63 (28%) of 229 active users on POD1 and decreased to 12 (12%) of 100 active users on POD7. Female sex (p .000), socioeconomic status (p .001), and surgical severity (p .001) showed statistically significant differences between active users, non-active users, and non-downloaders. Most patients active with the application experienced pain and nausea on the first and second day after discharge. Only a minority of the patients used the application. Those who used it were satisfied with the possibilities offered to them. Future research should focus on increasing the uptake and effect of this application on the quality of recovery.

AUTHOR SUMMARY

In the past, surgical recovery mainly occurred in hospitals. However, advancements in minimally invasive surgical techniques and anaesthesia have enabled us, to allow patients to recover at home after daycare surgery. It is common practice that we provide patients with verbal and written instructions for managing their pain and nausea after discharge. Nevertheless, we have noticed that patients often face challenges when attempting to contact the hospital in case of severe pain or nausea, and as healthcare professionals, we often lack insight into their recovery at home. To address these issues and improve patient care, we implemented a smartphone application called the OLVG Pain app specifically for our daycare surgical patients. The application empowers our patients to regularly report their pain and nausea scores and request consultations or adjustments to their medication as needed. Among the 4952 patients in our study, only a mere 7% actively used the app. We have found that postoperative pain and nausea were predominantly reported by the active users on postoperative day 1 and 2. The app’s low uptake and usage suggest that there may be potential barriers related to the digital divide, particularly among our patient population. Further research is needed to explore these barriers, improve adoption rates, and assess the app’s impact on postoperative recovery.