Digital Follow-Up After Elective Laparoscopic Cholecystectomy: A Feasibility Study

Abstract

Background: Although recommendations exist for patients to be offered a post-operative helpline or telephone follow-up appointment at discharge after cholecystectomy, implementation of these is resource-intensive. Whilst the benefits of telephone follow-up are well documented, the use of digital modalities is less so. We aimed to identify if digital follow-up (DFU) was equivalent to routine care with telephone follow-up (TFU), for patients undergoing elective laparoscopic cholecystectomy.

Methods: All patients listed for elective laparoscopic cholecystectomy between August 2016 and March 2018 were offered routine post-operative care (TFU or no follow-up) or DFU at a tertiary referral centre in Nottingham.

Results: Of 597 patients undergoing laparoscopic cholecystectomy, 199 (33.3%) opted for TFU, and 98 (16.4%) for DFU. DFU was completed for 85 (86.7%) participants and TFU for 125 (62.8%), p < 0.0001. Over 5 times as many patients who chose TFU missed their appointment compared to DFU (5.6% vs. 30.9%, p < 0.001). At 30-days post-operatively, patients undergoing TFU had significantly more post-operative wound infections identified then those undergoing DFU (17.6% vs 5.9%, p = 0.01). However, this did not impact the incidence of 30-day readmissions between groups (7.2% TFU vs. 7.1% DFU). No complications were missed by either the DFU or TFU modalities. DFU was completed significantly earlier than TFU (median 6 days vs. 13.5 days, p = 0.001) with high patient acceptability, identifying complications and alerting clinicians to those patients requiring an early review.

Conclusion: This feasibility study has demonstrated that digital follow-up is an acceptable alternative to telephone follow-up after elective laparoscopic cholecystectomy.

Trial registration: ClinicalTrials.gov NCT02810860.

Conflict of interest statement

Simon L Parsons is a company director for EIDO Healthcare Limited. None of the other authors has a conflict of interest to declare.

© 2022. The Author(s).

Figures

Fig. 1

Participant recruitment (STROBE diagram). DNA: Did not attend (patient missed their appointment despite prompting). *Non-standard operation = open cholecystectomy, laparoscopic cholecystectomy combined with another operation such as liver resection or gastric bypass. **Excluded = follow-up performed at ≥ 31 days post-operatively

Fig. 2

a Complications identified by digital follow-up survey: category scores. Cumulative scores for each category of the post-operative digital follow-up questionnaire. Scores ≥ 3 (shown in red) for each category triggered participants to have telephone follow-up. b Complications identified by digital follow-up survey: total scores. Cumulative scores for all 12 questions of the post-operative digital follow-up questionnaire. Scores ≥ 9 (shown in red) overall triggered participants to have telephone follow-up