Can a simple smartphone app that sends a daily symptoms questionnaire to patients recovering from pancreatic surgery help them avoid postsurgical complications?
That’s what Andrii Khomiak, MD, PhD, a fifth-year resident in the University of Colorado Anschutz Department of Surgery, set out to discover in research published recently in the journal Surgery. Sarah Tevis, MD, associate professor of surgical oncology, is the corresponding author.
“There can be a lot of complications after pancreatic surgeries, so the goal was to lower the complication rates and readmission rates of this very complex pancreatic surgery patient cohort,” Khomiak says. “The app sent them a questionnaire daily for two weeks following their surgery, so every day they got a notification on their phone to fill in how they're feeling today. Are they in pain? Are they nauseated?”
If patients answered yes to any of the symptom-related questions, the app triggered alerts to the UCHealth Virtual Health Center (VHC), prompting a tiered response from a VHC technician to a nurse or physician who would contact the patient for symptom verification. Most issues could be addressed via telehealth, though a few required emergency-room visits or escalation to the surgical team.
“The patients liked it, because they felt like they were being cared for and had a place to voice their concerns,” Khomiak says. “They preferred the app over calling someone, and sometimes they didn’t even know there were treatments for the things that were happening to them. We were able to advise them to take antinausea meds or take some stool softeners to prevent constipation.”
Khomiak says pancreatic surgery often results in complications because it’s an anatomically challenging area, and surgeries like a Whipple procedure involve multiple organs.
“The pancreas itself is a very hostile organ to work with, in terms of surgical operations,” he says. “It often leaks, and patients with those leaks can deteriorate fast. It's very important that you catch those early stages.”
Normally, patients with postoperative symptoms either call the clinic for assistance or go the emergency room, but the questionnaire-based app, paired with VHC monitoring, offered a more proactive way of monitoring symptoms and providing assistance when needed.
The app delivered a structured daily questionnaire assessing 10 symptom domains commonly associated with post-operative complications after pancreatic surgery, including abdominal pain, nausea/vomiting, poor oral intake, inability to pass gas or stool, fever or chills, dyspnea, dizziness/light-headedness, wound changes, and functional status. Patients received an automated daily push notification generated by the application and were instructed to complete the survey at approximately the same time each day.
The implementation study was conducted between August 2023 and February 2024, reporting on the first 13 patients to use the system. The data showed that most patients were highly satisfied with the process, citing convenience and a feeling of reassurance from daily monitoring. Patients who live farther away from CU Anschutz also appreciated the ability to be monitored remotely.
“This was a blueprint study for people who want to implement this, and already other surgery divisions are now interested in doing it for their patients,” Khomiak says. “I think it’s great, because it catches complications earlier. It’s a win-win situation — it's better for patients; it's better for clinicians.”