Abstract
Surgical site infections (SSI) cause substantial morbidity and pose a burden to acute healthcare services after surgery. We aimed to investigate whether a smartphone-delivered wound assessment tool can expedite diagnosis and treatment of SSI after emergency abdominal surgery. This single-blinded randomised control trial (NCT02704897) enroled adult emergency abdominal surgery patients in two tertiary care hospitals. Patients were randomised (1:1) to routine postoperative care or additional access to a smartphone-delivered wound assessment tool for 30-days postoperatively. Patient-reported SSI symptoms and wound photographs were requested on postoperative days 3, 7, and 15. The primary outcome was time-to-diagnosis of SSI (Centers for Disease Control definition). 492 patients were randomised (smartphone intervention: 223; routine care: 269). There was no significant difference in the 30-day SSI rate between trial arms: 21 (9.4%) in smartphone vs 20 (7.4%, p = 0.513) in routine care. Among the smartphone group, 32.3% (n = 72) did not utilise the tool. There was no significant difference in time-to-diagnosis of SSI for patients receiving the intervention (−2.5 days, 95% CI: −6.6−1.6, p = 0.225). However, patients in the smartphone group had 3.7-times higher odds of diagnosis within 7 postoperative days (95% CI: 1.02−13.51, p = 0.043). The smartphone group had significantly reduced community care attendance (OR: 0.57, 95% CI: 0.34−0.94, p = 0.030), similar hospital attendance (OR: 0.76, 95% CI: 0.28−1.96, p = 0.577), and significantly better experiences in accessing care (OR: 2.02, 95% CI: 1.17−3.53, p = 0.013). Smartphone-delivered wound follow-up is feasible following emergency abdominal surgery. This can facilitate triage to the appropriate level of assessment required, allowing earlier postoperative diagnosis of SSI.
Highlights
Surgical site infection (SSI) is one of the most common complications following gastrointestinal surgery[1], and increasingly occur after discharge with the move towards earlier patient discharge[2]
Patients were recruited between 26 July 2016 and 4 March 2020, and completion of recruitment preceded any known cases of SARS-CoV-2 infection in the local region
There were 717 patients undergoing emergency abdominal surgery screened for eligibility during this time (Fig. 1)
Summary
Surgical site infection (SSI) is one of the most common complications following gastrointestinal surgery[1], and increasingly occur after discharge with the move towards earlier patient discharge[2]. Diagnosis, and treatment of SSIs provide the best opportunities to minimise the associated burden of disease and promote rationalised antibiotic use. Over three-quarters (78%) of UK adults own smartphones[4], expanding the potential for digital health interventions. No clinical trial has been completed to demonstrate the effectiveness or efficacy of digital health interventions used for the purposes of remote wound assessment to identify SSI, nor their implications for patients or the health service. Remote wound monitoring poses an immense opportunity to understand and improve postoperative community care and minimise the burden of disease for both patients and healthcare services
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