Personalised perioperative care by e-health after intermediate-grade abdominal surgery: a multicentre, single-blind, randomised, placebo-controlled trial
Open accessAbstract
Background Instructing and guiding patients after surgery is essential for successful recovery. However, the time that health-care professionals can spend with their patients postoperatively has been reduced because of efficiency-driven, shortened hospital stays. We evaluated the effect of a personalised e-health-care programme on return to normal activities after surgery.Methods A multicentre, single-blind, randomised controlled trial was done at seven teaching hospitals in the Netherlands. Patients aged 18-75 years who were scheduled for laparoscopic cholecystectomy, inguinal hernia surgery, or laparoscopic adnexal surgery for a benign indication were recruited. An independent researcher randomly allocated participants to either the intervention or control group using computer-based randomisation lists, with stratification by sex, type of surgery, and hospital. Participants in the intervention group had access to a perioperative, personalised, e-health-care programme, which managed recovery expectations and provided postoperative guidance tailored to the patient. The control group received usual care and access to a placebo website containing standard general recovery advice. Participants were unaware of the study hypothesis and were asked to complete questionnaires at five timepoints during the 6-month period after surgery. The primary outcome was time between surgery and return to normal activities, measured using personalised patient-reported outcome measures. Intention-to-treat and per-protocol analyses were done. This trial is registered in the Netherlands National Trial Register, number NTR4699.Findings Between Aug 24, 2015, and Aug 12, 2016, 344 participants were enrolled and randomly allocated to either the intervention (n=173) or control (n=171) group. 14 participants (4%) were lost to follow-up, with 330 participants included in the primary outcome analysis. Median time until return to normal activities was 21 days (95% CI 17-25) in the intervention group and 26 days (20-32) in the control group (hazard ratio 1·38, 95% CI 1·09-1·73; p=0·007). Complications did not differ between groups.Interpretation A personalised e-health intervention after abdominal surgery speeds up the return to normal activities compared with usual care. Implementation of this e-health programme is recommended in patients undergoing intermediate-grade abdominal, gynaecological, or general surgical procedures.Funding ZonMw.
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High-quality evidence from multicenter randomized controlled trials has recently emerged demonstrating the potential of app-based interventions to improve treatment adherence in the management of hypertension and clinical outcomes from enhanced perioperative care after elective abdominal surgery.
“High-quality evidence from multicenter randomized controlled trials has recently emerged demonstrating the potential of app-based interventions to improve treatment adherence in the management of hypertension and clinical outcomes from enhanced perioperative care after elective abdominal surgery.”
From What is the clinical value of mHealth for patients? (2020) · cites this paper as [16]
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- Authors
- van der Meij, E., Anema, J. R., Leclercq, W. K. G., Bongers, M. Y., Consten, E. C. J., Schraffordt Koops, S. E., van de Ven, P. M., Terwee, C. B., van Dongen, J. M., Schaafsma, F. G., Meijerink, W. J. H. J., Bonjer, H. J., & Huirne, J. A. F.
- Affiliations
- Amsterdam Public Health (NL)
- Máxima Medisch Centrum (NL)
- Maastricht University (NL)
- Meander Medisch Centrum (NL)
- Radboud University Medical Center (NL)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Corresponding author
- Anema, Johannes R
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2018-07
- Volume
- 392
- Issue
- 10141
- Pages
- 51-59
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2808855936
- Cited by
- 114
- References
- 31
- Citations by year
- 2026: 10 · 2025: 17 · 2024: 17 · 2023: 12 · 2022: 13 · 2021: 15 · 2020: 18 · 2019: 10 · 2018: 2
- FWCI
- 17.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion)
- Funders
- ZonMw (837002409)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Keywords
- postoperative recovery, return to normal activity, laparoscopic cholecystectomy, inguinal hernia repair, patient-reported outcome measures, recovery expectations, gynecologic surgery, online intervention, patient education
- MeSH terms
- Abdomen, Activities of Daily Living, Adult, Female, Humans, Male, Middle Aged, Patient Education as Topic, Surveys and Questionnaires, Single-Blind Method, Telemedicine, Perioperative Care, Internet, Precision Medicine
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