Remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients

Citation

McLean KA, Mountain KE, Shaw CA, Drake TM, Pius R, Knight SR, Fairfield CJ, Sgrò A, Bouamrane M, Cambridge WA, Lyons M, Riad A, Skipworth RJE, Wigmore SJ, Potter MA, Harrison EM, Baweja K, Cambridge WA, Chauhan V, Czyzykowska K, Edirisooriya M, Forsyth A, Fox B, Fretwell J, Gent C, Gherman A, Green L, Grewar J, Heelan S, Henshall D, Iiuoma C, Jayasangaran S, Johnston C, Kennedy E, Kremel D, Kung J, Kwong J, Leavy C, Liu J, Mackay S, MacNamara A, Mowitt S, Musenga E, Ng N, Ng ZH, O’Neill S, Ramage M, Reed J, Riad A, Scott C, Sehgal V, Sgrò A, Steven L, Stutchfield B, Tominey S, Wilson W, Wojtowicz M, Yang J & TWIST Collaborators (2021) Remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients. npj Digital Medicine, 4 (1). https://www.nature.com/articles/s41746-021-00526-0; https://doi.org/10.1038/s41746-021-00526-0

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.

Keywords
Randomised Controlled Trial in Emergency Surgery Patients, Digital Post-operative Remote Monitoring, Mobile Health, Surgical Site / Wound Infection

Journal
npj Digital Medicine: Volume 4, Issue 1

People

Professor Matt-Mouley Bouamrane

Professor in Health/Social Informatics, Computing Science