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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2024

14-02-2024 | Mastectomy | Reconstructive Oncology

Remote Symptom Monitoring with Clinical Alerts Following Mastectomy: Do Early Symptoms Predict 30-Day Surgical Complications

Authors: Jacqueline J. Chu, MD, MS, Audree B. Tadros, MD, Perri S. Vingan, BS, Melissa J. Assel, MS, Taylor M. McCready, MPH, Andrew J. Vickers, PhD, Sigrid Carlsson, MD, PhD, MPH, Monica Morrow, MD, Babak J. Mehrara, MD, Carrie S. Stern, MD, Andrea L. Pusic, MD, Jonas A. Nelson, MD, MPH

Published in: Annals of Surgical Oncology | Issue 5/2024

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Abstract

Background

Electronic patient-reported outcome measures (ePROMs) for real-time remote symptom monitoring facilitate early recognition of postoperative complications. We sought to determine whether remote, electronic, patient-reported symptom-monitoring with Recovery Tracker predicts 30-day readmission or reoperation in outpatient mastectomy patients.

Methods

We conducted a retrospective review of breast cancer patients who underwent outpatient (< 24-h stay) mastectomy with or without reconstruction from April 2017 to January 2022 and who received the Recovery Tracker on Days 1–10 postoperatively. Of 5,130 patients, 3,888 met the inclusion criteria (2,880 mastectomy with immediate reconstruction and 1,008 mastectomy only). We focused on symptoms concerning for surgical complications and assessed if symptoms reaching prespecified alert levels—prompting a nursing call—predicted risk of 30-day readmission or reoperation.

Results

Daily Recovery Tracker response rates ranged from 45% to 70%. Overall, 1,461 of 3,888 patients (38%) triggered at least one alert. Most red (urgent) alerts were triggered by pain and fever; most yellow (less urgent) alerts were triggered by wound redness and pain severity. The 30-day readmission and reoperation rates were low at 3.8% and 2.4%, respectively. There was no statistically significant association between symptom alerts and 30-day reoperation or readmission, and a clinically relevant increase in risk can be excluded (odds ratio 1.08; 95% confidence interval 0.8–1.46; p = 0.6).

Conclusions

Breast cancer patients undergoing mastectomy with or without reconstruction in the ambulatory setting have a low burden of concerning symptoms, even in the first few days after surgery. Patients can be reassured that symptoms that do present resolve quickly thereafter.
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Metadata
Title
Remote Symptom Monitoring with Clinical Alerts Following Mastectomy: Do Early Symptoms Predict 30-Day Surgical Complications
Authors
Jacqueline J. Chu, MD, MS
Audree B. Tadros, MD
Perri S. Vingan, BS
Melissa J. Assel, MS
Taylor M. McCready, MPH
Andrew J. Vickers, PhD
Sigrid Carlsson, MD, PhD, MPH
Monica Morrow, MD
Babak J. Mehrara, MD
Carrie S. Stern, MD
Andrea L. Pusic, MD
Jonas A. Nelson, MD, MPH
Publication date
14-02-2024
Publisher
Springer International Publishing
Keyword
Mastectomy
Published in
Annals of Surgical Oncology / Issue 5/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-024-15031-3

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