Postsurgical Medication Awareness, Recovery, and Tracking using a Phone-Based App (SMART-APP): a randomized clinical...

Excess postoperative opioid use is harmful. We tested the hypothesis that a patient-facing educational smartphone app would permit surgical patients to effectively manage their pain while using fewer opioids after discharge.

A two-hospital, single-health system trial randomly exposed adult surgical inpatients to a consumer electronic health app ("educational app") that provided pain education or to a data collection only app ("control app"). During the second half of the trial, a clinician-facing electronic decision-support tool was activated. Linear regression models with log-transformed outcomes estimated the effect of the educational app on the primary outcome of cumulative self-reported opioid use within 4 weeks after discharge (in morphine milligram equivalents (MME)) and the secondary outcome of opioids prescribed at discharge.

We enrolled 711 patients from May 2, 2022, to December 10, 2023. The modified intention-to-treat analysis cohort included 606 patients, with 303 randomized to the educational app and 303 to the control app. Median (first quartile, third quartile) discharge opioids prescribed to both groups were 75 (60, 150) MME. Median (Q1, Q3) self-reported cumulative opioid use in the 4 weeks after discharge was 22 (0, 98) MME with the educational app and 15 (0, 82) MME with the control app (ratio of geometric means: 1.21; 95% CI 0.87 to 1.69; p=0.264). The use of the clinician-facing electronic decision-support tool also did not modify opioid consumption.

Neither a patient-facing educational app nor a clinician-facing decision support tool reduced self-reported opioid consumption among surgical patients with low post-discharge opioid requirements.

NCT05221866.