Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK.
Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, City Hospital Campus, Hucknall Road, Nottingham, UK.
World J Surg. 2022 Nov;46(11):2648-2658. doi: 10.1007/s00268-022-06684-w. Epub 2022 Aug 11.
Although recommendations exist for patients to be offered a post-operative helpline or telephone follow-up appointment at discharge after cholecystectomy, implementation of these is resource-intensive. Whilst the benefits of telephone follow-up are well documented, the use of digital modalities is less so. We aimed to identify if digital follow-up (DFU) was equivalent to routine care with telephone follow-up (TFU), for patients undergoing elective laparoscopic cholecystectomy.
All patients listed for elective laparoscopic cholecystectomy between August 2016 and March 2018 were offered routine post-operative care (TFU or no follow-up) or DFU at a tertiary referral centre in Nottingham.
Of 597 patients undergoing laparoscopic cholecystectomy, 199 (33.3%) opted for TFU, and 98 (16.4%) for DFU. DFU was completed for 85 (86.7%) participants and TFU for 125 (62.8%), p < 0.0001. Over 5 times as many patients who chose TFU missed their appointment compared to DFU (5.6% vs. 30.9%, p < 0.001). At 30-days post-operatively, patients undergoing TFU had significantly more post-operative wound infections identified then those undergoing DFU (17.6% vs 5.9%, p = 0.01). However, this did not impact the incidence of 30-day readmissions between groups (7.2% TFU vs. 7.1% DFU). No complications were missed by either the DFU or TFU modalities. DFU was completed significantly earlier than TFU (median 6 days vs. 13.5 days, p = 0.001) with high patient acceptability, identifying complications and alerting clinicians to those patients requiring an early review.
This feasibility study has demonstrated that digital follow-up is an acceptable alternative to telephone follow-up after elective laparoscopic cholecystectomy.
尽管有建议提出，在胆囊切除术后出院时应为患者提供术后热线或电话随访预约，但这些建议的实施需要耗费大量资源。虽然电话随访的益处已得到充分证实，但数字模式的应用却相对较少。我们旨在确定数字随访（DFU）是否与常规的电话随访（TFU）等效，适用于接受择期腹腔镜胆囊切除术的患者。
在诺丁汉的一家三级转诊中心，所有接受择期腹腔镜胆囊切除术的患者都被提供常规术后护理（TFU 或无随访）或 DFU。
在 597 例接受腹腔镜胆囊切除术的患者中，有 199 例（33.3%）选择了 TFU，98 例（16.4%）选择了 DFU。有 85 名（86.7%）参与者完成了 DFU，而 125 名（62.8%）参与者完成了 TFU，p < 0.0001。与 DFU 相比，选择 TFU 的患者错过预约的比例高出 5 倍以上（5.6%比 30.9%，p < 0.001）。在术后 30 天，接受 TFU 的患者中明显比接受 DFU 的患者有更多的术后伤口感染（17.6%比 5.9%，p = 0.01）。然而，这并没有影响两组之间 30 天内再次入院的发生率（TFU 为 7.2%，DFU 为 7.1%）。DFU 和 TFU 两种方式都没有遗漏任何并发症。DFU 的完成时间明显早于 TFU（中位数为 6 天比 13.5 天，p = 0.001），同时具有较高的患者接受度，能够识别并发症，并提醒临床医生关注需要早期复查的患者。
这项可行性研究表明，数字随访是择期腹腔镜胆囊切除术后替代电话随访的一种可接受的方式。
