JMIR Publications

ABSTRACT

Background:

Enhanced Recovery After Surgery (ERAS) pathways have significantly shortened postoperative inpatient stay for elective colorectal procedures. Consequently, earlier discharge has thinned the safety net at home, with limited access to primary care and overstretched emergency departments. Digital postoperative follow-up tools have been proposed as a mitigating measure; however, doubts stay regarding whether patient compliance depends on the presence of a known clinician on the receiving end of the channel.

Objective:

To evaluate patient experience and acceptability of a digital post-operative follow-up pathway within a consultant led colorectal and general surgical service. Our two aims are to evaluate patient experience of a digital post-operative pathway with a twelve-item questionnaire and to compare this data with national benchmarking for provider-level postoperative length of stay for elective colon and rectal cancer resection against the NHS Model Hospital dataset.

Methods:

This retrospective service evaluation analysed anonymised feedback from patients who used a postoperative digital application (PostOp.ai) within a consultant-led colorectal and general surgical pathway to submit data such as recovery questionnaires, wound photographs after discharge, and messages to a named advanced clinical practitioner. A twelve-item feedback questionnaire was distributed to 157 patients; 72 returned a complete response (45.9%). Categorical items were summarised using frequencies and percentages, ease of photograph upload was rated on a six-point scale, and free-text responses were analysed thematically. Provider-level length of stay performance was compared against the National Health Service Model Hospital national dataset.

Results:

Eighty-eight percent of respondents reported that the application was easy to use, 83% that it aided recovery, and 86% that it improved their confidence during recovery. Sixty-nine percent used the messaging function; of those, 96% were satisfied with the team's reply and 90% with the response time. Eighty-five percent reported that the application had allowed them to recover without contacting their general practitioner, the emergency department, or the surgical team directly, and 82% would recommend it to others. The aggregate compliance score across scored items was 412 of 485 (84.9%). Thematic analysis of free-text responses identified four recurring themes: reassurance and reduced anxiety at home, accessibility of a familiar clinician, time and travel savings, and a clear preference for human-mediated digital contact over automated alternatives. National benchmarking showed a median postoperative length of stay of 4.0 days for elective colon resection and 3.5 days for elective rectal resection, both within the lowest quartile of all reporting providers.

Conclusions:

A digital postoperative follow-up application in which a named clinician responds at the other end of the channel was acceptable and valued by patients and was associated with a self-reported reduction in unscheduled clinical contacts. The 85% “avoided contact” rate observed here provides an empirical anchor for a previously published model-based cost-effectiveness analysis from the same service, which estimated NHS and public savings of between £58,739 and £79,949 per 100 patients. The qualitative emphasis on a familiar, responsive human responder supports an embedded human in the loop design for postoperative digital monitoring, rather than an automated approach. digit