P. Dolan1, H. Yeo1,2 1Weill Cornell Medical College,Surgery,New York, NY, USA 2Weill Cornell Medical College,Healthcare Policy And Research,New York, NY, USA
Introduction: Weight-loss surgery has been shown to be the most effective way to lose weight, but remains under-utilized. One reason is due to the initial cost of surgery, including the subsequent inpatient hospitalization as well as readmissions. Although the complication rate from weight-loss surgery is declining over time, currently about 11% of patients visit an emergency room within 30 days after surgery, leading to 4.4% of patients being readmitted. The most common complications leading to ER visits are dehydration and abdominal pain, both costly and potentially avoidable with appropriate early intervention and triaging. Length of stay after the initial procedure is also becoming shorter, however, most patients stay at least 1-2 days in the hospital after surgery. Mobile health apps have been tested in other patient populations and have been shown to decrease length of stay and improve outcomes. Our goal is to develop and test a mobile health application to assess patients’ recovery and triage common issues in the 30 days after weight-loss surgery, such as dehydration, nausea, and abdominal pain. Use of the app will hopefully decrease cost by shortening length of stay and reducing readmission rates.
Methods: Mixed methods, single-center prospective pilot/feasibility study of all eligible English-speaking adults undergoing weight-loss surgery. We have been developing and refining the mobile app over the course of the last 12 months. The app has multiple components, one of which is a daily survey. Survey questions were developed to monitor post op recovery and symptoms. These questions were developed through a review of the literature and by interviewing bariatric nutritionists, bariatric nurse specialists and attending bariatric surgeons in conjunction with an experienced survey developer. Patients also get push notifications with reminders designed to improve recovery. After the first few patients had completed the pilot, the app was revised based on patient feedback. The app is currently being tested and refined on additional patients.
Results: After our first three 3 patients completed the 30-day trial period they were surveyed to find out preference and usability of the app. All patients expressed satisfaction with the app. Patients reported that push notifications were helpful. However, patients were frustrated with the length of surveys after the first few days. Especially if they were doing well after surgery, they found the surveys to be redundant. Therefore, we tailored the app to patients’ feedback, to a simpler system with shorter follow-up surveys. We are now testing the app further, for feasibility and usability.
Conclusion: App development is feasible, but complex and must be tailored to the procedure and the patient. They require a significant amount of time to develop and refine to patient needs. Our next steps are to pilot the app a larger set of patients and assess utility and feasibility in practice.