JMIR Publications

ABSTRACT

Background:

Postoperative outcome assessment is often limited by infrequent follow-up visits and incomplete capture of patient-reported well-being and adverse events. Smartphone-based monitoring may provide continuous, patient-centered insights into recovery trajectories after surgery.

Objective:

To develop and evaluate the feasibility of a smartphone-based application for longitudinal monitoring of quality of life and adverse events after elective neurosurgery.

Methods:

This interim analysis of a prospective cohort study included adult patients undergoing elective lumbar decompression, lumbar fusion, supratentorial craniotomy, or infratentorial craniotomy at a Swiss tertiary referral center between June 2023 and January 2025. Participants used a smartphone application to longitudinally report subjective well-being (SWI, 0–10), quality of life (EQ-5D-5L), and AEs for up to one year postoperatively. AEs were self-reported using the Therapy-Disability-Neurology (TDN) classification and retrospectively adjudicated by physicians. Descriptive analyses assessed data density, engagement, and concordance between patient- and clinician-reported events. Mixed-effects models were used to evaluate factors associated with postoperative well-being.

Results:

Among 100 enrolled patients (median age, 64.0 years [IQR, 52.9–71.6]; 45% women), 86 provided postoperative data. During a median follow-up of 3.2 months (IQR, 0.2–11.3), participants submitted 4354 longitudinal well-being entries. Patients reported 22 unique adverse events, whereas physicians identified 44 adverse events, with overlap for 9 events (20.5%). Most physician-reported adverse events were mild (30 of 44 [68.2%], TDN grade 1–2), and no grade 4 or 5 events occurred. Patient-reported adverse events primarily reflected symptomatic and functional impairments, whereas physician-reported events more often included clinically detected or subclinical findings. In mixed-effects models, time since surgery was associated with improved well-being, and no other factors were statistically significant.

Conclusions:

These results support smartphone-based postoperative monitoring as a scalable, patient-driven approach that complements clinical evaluations and provides patient-centered insights into recovery trajectories beyond conventional follow-up. Clinical Trial: The study was registered at ClinicalTrials.gov (NCT06352710).