Pilot trial of remote monitoring to prevent malnutrition after hepatopancreatobiliary surgery

Kelvin Allenson, Kea Turner, Brian D Gonzalez, Erin Gurd, Sarah Zhu, Nicole Misner, Alicia Chin, Melissa Adams, Laura Cooper, Diana Nguyen, Samer Naffouje, Diana L Castillo, Maria Kocab, Brian James, Jason Denbo, Jose M Pimiento, Mokenge Malafa, Benjamin D Powers, Jason B Fleming, Daniel A Anaya, Pamela J Hodul, Kelvin Allenson, Kea Turner, Brian D Gonzalez, Erin Gurd, Sarah Zhu, Nicole Misner, Alicia Chin, Melissa Adams, Laura Cooper, Diana Nguyen, Samer Naffouje, Diana L Castillo, Maria Kocab, Brian James, Jason Denbo, Jose M Pimiento, Mokenge Malafa, Benjamin D Powers, Jason B Fleming, Daniel A Anaya, Pamela J Hodul

Abstract

Background: Patients undergoing hepatopancreatobiliary (HPB) surgery, such patients with pancreatic, periampullary, and liver cancer, are at high risk for malnutrition. Malnutrition increases surgical complications and reduces overall survival. Despite its severity, there are limited interventions addressing malnutrition after HPB surgery. The aim of this pilot trial was to examine feasibility, acceptability, usability, and preliminary efficacy of a remote nutrition monitoring intervention after HPB surgery.

Methods: Participants received tailored nutritional counseling before and after surgery at 2 and 4 weeks after hospital discharge. Participants also recorded nutritional intake daily for 30 days, and these data were reviewed remotely by registered dietitians before nutritional counseling visits. Descriptive statistics were used to describe study outcomes.

Results: All 26 patients approached to participate consented to the trial before HPB surgery. Seven were excluded after consent for failing to meet eligibility criteria (e.g., did not receive surgery). Nineteen participants (52.6% female, median age = 65 years) remained eligible for remote monitoring post-surgery. Nineteen used the mobile app food diary, 79% of participants recorded food intake for greater than 80% of study days, 95% met with the dietitian for all visits, and 89% were highly satisfied with the intervention. Among participants with complete data, the average percent caloric goal obtained was 82.4% (IQR: 21.7).

Conclusions: This intervention was feasible and acceptable to patients undergoing HPB surgery. Preliminary efficacy data showed most participants were able to meet calorie intake goals. Future studies should examine intervention efficacy in a larger, randomized controlled trial.

Trial registration: Clinicaltrials.gov. Registered 16 September 2019, https://ichgcp.net/clinical-trials-registry/NCT04091165 .

Keywords: Cancer; Digital health; Hepatopancreaticobiliary; Malnutrition; Mobile app; Nutrition; Surgery.

Conflict of interest statement

Dr. Gonzalez has received consulting fees from SureMed Compliance and KemPharm. Dr. Gonzalez participates on an advisory board for EllyHealth. Dr. Hodul has served on a speaker bureau for Abbvie. The other authors do not have any conflicts of interest to disclose.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Weekly caloric goal attainment among study participants

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