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eHealth in Pediatric Surgery: Impact on Postsurgical Care After Reconstructive Surgery for Anorectal Malformations
Matilda Wester Fleur1, Björn A Johnsson2, Charlotte Castor3
1Department of Clinical Sciences, Pediatrics, Faculty of Medicine, Lund University, 221 00 Lund, Sweden; Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, 221 85 Lund, Sweden; Department of Health Sciences, Faculty of Medicine, Lund University, 221 00 Lund, Sweden.
Insights
eHealth technology improves postoperative care for anorectal malformations (ARM) and Hirschsprung
Area of Science:
- Pediatric Surgery
- eHealth
- Digital Health
Background:
- Postoperative care for anorectal malformations (ARM) and Hirschsprung's disease (HD) requires robust family support.
- An eHealth device was developed to facilitate bilateral communication between families and healthcare providers.
- The device supports communication via chat, photos, questionnaires, and video.
Purpose of the Study:
- To evaluate the impact of eHealth on postoperative care patterns following ARM and HD surgery.
- To compare expert consultation frequency, complication rates, and treatment adjustments between eHealth users and conventional care groups.
- To assess the effectiveness of eHealth in supporting families after discharge.
Main Methods:
- An interventional prospective case-control study was conducted.
- The study observed 95 families over 30 days post-discharge (July 2018-July 2023).
- Outcomes were compared between families using the eHealth device and those receiving conventional care.
Main Results:
- eHealth users had significantly fewer days to first contact (ARM: 2 vs. 5.5 days; HD: 1 vs. 7 days).
- eHealth use led to more frequent consultations, particularly with nurses (ARM: 9 vs. 4 days; HD: 12 vs. 3.5 days).
- ARM patients using eHealth experienced fewer and less severe complications (23% vs. 50%; Clavien-Madadi 0 vs. 1).
- HD patients using eHealth had more frequent treatment adjustments (3 vs. 2).
Conclusions:
- eHealth facilitates earlier and more frequent postoperative counseling, especially nurse-led support, after ARM and HD reconstructions.
- eHealth use is associated with reduced complication severity in ARM patients.
- eHealth enables more timely treatment adjustments for HD patients.
Background:
To support care after discharge following surgery for anorectal malformations (ARM) and Hirschsprung's disease (HD), an eHealth device was invented, offering families bilateral communication through chat, photo, questionaries and video.
Aim:
To explore the impact of eHealth on postoperative patterns of expert consultation, complications and treatment after discharge following surgery for ARM and HD, respectively, compared to conventional care.
Method:
Interventional prospective case control study observing postoperative care 30 days after discharge after ARM and HD-reconstructions July 2018-July 2023, comparing outcomes between families using the eHealth device versus conventional care.
Results:
Consecutively included were 95/141 families (eHealth: ARM n = 48, HD n = 25; respective conventional care: ARM n = 16, HD n = 6). Days to first contact after discharge were fewer for eHealth users, both for ARM 2 vs. 5.5 (p = 0.000) and HD 1 vs 7 (p = 0.000). Days with consultations were more numerous using eHealth: ARM 9 vs 4 (p = 0.000) and HD 12 vs 3.5 (p = 0.001) specifically nurse counseling; ARM 6 versus 1 (p = 0.000) and HD 11 vs 2.5 (p = 0.001). In ARM patients the complication frequency was 23 % (eHealth) versus 50 % (conventional), and the complication severity was lower: Clavien-Madadi 0 (0-4) versus 1 (0-3) (p = 0.040). Treatment adjustments were more frequent for HD patients using eHealth (3 vs. 2 (p = 0.041)).
Conclusion:
Use of eHealth after ARM respective HD reconstructions implies earlier and more frequent postoperative counseling, especially with nurses. When using eHealth complications were less severe in ARM-patients and treatment adjustments more frequent in the HD patients, compared to those under conventional care.
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