JMIR Publications

ABSTRACT

Background:

Electronic health can help replicate the benefits of conventional surgical pre-habilitation programs and, overcome organizational constraints related to human resources and healthcare-related costs.

Objective:

We aimed to assess the impact of an optimized perioperative program using a personalized mobile app designed for preparation and recovery after radical prostatectomy (RP).

Methods:

This is a single-surgeon series of 122 consecutive robot-assisted RP before and after the implementation of the betty.care app(cohort A: standard of care, n=60; cohort B: optimized program, n=62). Primary endpoint was continence recovery, defined as “0 or 1 safety pad per day” at 6 weeks after surgery. Secondary endpoints were length of stay, same-day discharge, complications, readmissions and number of days alive and out of hospital within 30 days from surgery.

Results:

Both cohorts were comparable in terms of age (64.4 years), PSA (mean 8.9), prostate volume (mean 43.7 cc), and disease aggressiveness (41% ISUP 3 or more, 36.8% of pT3 disease). Intraoperative parameters (lymph node dissection: 52.5%; operative time: 83.3 min; bilateral nerve-sparing surgery: 86.1%) were comparable in both groups, except for blood loss which was significantly higher in cohort B (182 versus 125 cc, p=0.008). The 6-week continence rate was improved in cohort B in both univariable and multivariable analyses (91.9% versus 75.0%, p=0.012). There were trends favoring cohort B for all secondary endpoints with a minimal 30% benefit compared with cohort A. Grade 2 or more complications occurred less frequently in cohort B (13.3% versus 3.2%, p=0.042). Same-day discharge and readmission rates were 35.0% and 53.2% (p=0.043), and 3.3% and 1.6% (p=0.540) in cohorts A and B, respectively. Mean length of stay was reduced by 0.2 days in cohort B (0.58 vs 0.78 days, p=0.114). The main limitation was the absence of randomization.

Conclusions:

The implementation of a mobile app which provides a holistic approach to the perioperative period, integrating prehabilitation, rehabilitation and remote monitoring could lead to the improvement of important functional outcomes after RP and could replicate an on-site prehabilitation program. Multicenter validation is needed.