Huber Hans M, Wei Iris H, Abbass Mohammad Ali, Karagkounis Georgios, Widmar Maria, Smith J Joshua, Nash Garrett M, Weiser Martin R, Paty Philip B, Garcia-Aguilar Julio, Pappou Emmanouil
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
Cancers (Basel). 2025 Jun 11;17(12):1939. doi: 10.3390/cancers17121939.
Remote symptom monitoring via electronic platforms may identify patients at risk for unplanned acute care visits after surgery. Since 2016, the Memorial Sloan Kettering Cancer Center (MSKCC) has employed the Recovery Tracker (RT), a patient-reported outcome (PRO) system, for symptom monitoring after ambulatory procedures. In 2021, RT was extended to patients undergoing inpatient colorectal surgery. To evaluate the impact of RT implementation on urgent care utilization and readmission rates in patients undergoing elective inpatient colorectal surgery and to determine whether patient engagement with RT influences these outcomes. In this retrospective observational study at MSKCC, we compared patients undergoing elective colorectal surgery during the RT implementation period (March 2021-December 2022) to a historical control cohort (February 2019-February 2020). The primary outcome was a potentially unnecessary urgent care center (UCC) visits-defined as a visit not requiring inpatient admission. Secondary outcomes included 30-day readmission and survey engagement. Multivariable logistic regression was used for adjusted comparisons. A total of 1941 patients in the RT cohort and 1206 in the control group met the inclusion criteria. The RT cohort had higher rates of UCC visits without admission (4.43% vs. 1.6%) and 30-day readmissions (9.74% vs. 6.88%). RT period surgery was independently associated with increased odds of UCC visits (OR 2.80, 95% CI 1.71-4.58, < 0.0001) and readmissions (OR 1.43, 95% CI 1.09-1.88, = 0.0098). Notably, RT users who completed at least one survey (70.2%) had significantly lower odds of readmission (OR 0.56, 95% CI 0.41-0.77, = 0.0003) compared to non-responders. Engagement with the RT system was associated with a 44% reduction in readmission risk, identifying non-responders as a vulnerable subgroup. While the overall rates of post-discharge care utilization increased after RT implementation, active participation in PRO reporting emerged as a protective factor. These findings highlight the need for strategies to promote engagement and support patients less likely to interact with remote monitoring tools. Non-response may signal barriers such as technological challenges or increased vulnerability, warranting proactive engagement strategies.
通过电子平台进行远程症状监测可能会识别出术后有计划外急性护理就诊风险的患者。自2016年以来，纪念斯隆凯特琳癌症中心（MSKCC）一直使用康复追踪器（RT），这是一种患者报告结局（PRO）系统，用于门诊手术后的症状监测。2021年，RT扩展到接受住院结直肠手术的患者。旨在评估RT实施对接受择期住院结直肠手术患者的紧急护理利用率和再入院率的影响，并确定患者对RT的参与是否会影响这些结果。在MSKCC进行的这项回顾性观察研究中，我们将RT实施期间（2021年3月至2022年12月）接受择期结直肠手术的患者与历史对照组（2019年2月至2020年2月）进行了比较。主要结局是潜在不必要的紧急护理中心（UCC）就诊，定义为不需要住院治疗的就诊。次要结局包括30天再入院和调查参与情况。采用多变量逻辑回归进行调整比较。RT队列中有1941名患者，对照组中有1206名患者符合纳入标准。RT队列中未经住院的UCC就诊率（4.43%对1.6%）和30天再入院率（9.74%对6.88%）更高。RT期间的手术与UCC就诊几率增加（OR 2.80，95%CI 1.71 - 4.58，<0.0001）和再入院几率增加（OR 1.43，95%CI 1.09 - 1.88，=0.0098）独立相关。值得注意的是，与未回复者相比，至少完成一项调查的RT用户（70.2%）再入院几率显著降低（OR 0.56，95%CI 0.41 - 0.77，=0.0003）。与RT系统的参与与再入院风险降低44%相关，将未回复者确定为一个脆弱亚组。虽然RT实施后出院后护理利用率的总体率有所增加，但积极参与PRO报告成为一个保护因素。这些发现凸显了制定策略以促进参与并支持不太可能与远程监测工具互动的患者的必要性。未回复可能表明存在技术挑战或脆弱性增加等障碍，需要采取积极的参与策略。
