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JU INSIGHT: Mobile Postoperative Symptom Intervention Tool and Biometric Monitoring After Radical Cystectomy: Pilot Study Evaluating Feasibility, Usability, and Potential Utility

By: Heather L. Huelster, MD; Logan Zemp, MD; Kea Turner, PhD, MPH; Brian D. Gonzalez, PhD; Heather Jim, PhD; L. Robert Gore, PhD; Scott M. Gilbert, MD | Posted on: 16 Feb 2023

Huelster HL, Zemp L, Turner K, et al. Mobile postoperative symptom intervention tool and biometric monitoring after radical cystectomy: pilot study evaluating feasibility, usability, and potential utility. J Urol. 2023;209(2):410-421.

Study Need and Importance

Despite advances in surgical techniques and perioperative recovery pathways, persistently high complication and hospital readmission rates after cystectomy underscore a high-yield opportunity for intervention during postsurgical recovery. Mobile health applications offer an appealing and increasingly accessible platform for structured patient-reported symptom monitoring and incorporation of patient-generated health data captured by wearable devices. However, data supporting this technology’s integration into clinical and postoperative care are extremely limited.

What We Found

Here we describe the development of a mobile application-based postoperative symptom intervention tool for patients recovering from major abdominal surgery. A prospective pilot cohort of bladder cancer patients undergoing cystectomy was asked to complete a daily symptom questionnaire and wear a biometric monitoring watch for 30 days after hospital discharge. Participants found the mobile platform and patient-reported symptom application easy to navigate with high compliance (78%) with daily survey completion. Exploratory analysis correlating symptom response profiles and biometrics with postoperative clinical events suggested identifiable trends may signal developing complications (see Figure).

Figure. A, Patient-facing mobile postoperative symptom intervention tool (POSIT). Data visualization of daily POSIT profiles in absence of complication (B), presence of unplanned health care encounter (red line) and complication (black line; C), and presence of complication requiring readmission (gray bar; D). PRO-CTCAE indicates Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events.

Limitations

The modest pilot size of 15 patients limits quantitative correlation of clinical outcomes with symptom scores and biometric phenotypes. Additionally, symptom and biometric data were retrospectively correlated with adverse clinical events. Larger-scale data collection with real-time evaluation of symptom scores and biometric variables and provider response to this information will be necessary to identify signals for clinically important outcomes that may benefit from additional evaluation or intervention.

Interpretation for Patient Care

Smartphones and wearable technology can be used to capture patient-reported symptoms and biometric data after major surgery, such as radical cystectomy for bladder cancer. Symptom scores and patient-generated health data may signal developing complications and help clinicians identify postsurgical patients who may benefit from intervention.

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