The implementation of a mobile application and web-based platform for peri-operative patient-tailored education and tracking of patient-reported outcomes after esophagectomy

The peri-operative period surrounding esophagectomy is challenging for patients to navigate. In this study, we describe the implementation of a digital health pathway to provide peri-operative education and track patient reported outcomes (PRO) after esophagectomy. This single-center study involved adults who underwent esophagectomy between 2021 and 2024. Educational emails, PRO surveys, and quality of life (QOL) questionnaires were delivered via a mobile health (mHealth) platform (CareSense; MedTrak Inc). Pathway data were combined with outcome data. Primary outcome was the rate of post-operative complications. Secondary outcomes included enrollment rate, PRO, and QOL scores. Fisher's exact test, Pearson Chi-square test, Kruskal-Wallis test, and logistic regressions were utilized for statistical analyses. Of 168 eligible patients, 136 (80.9%) enrolled in the pathway. There were no significant differences in demographic characteristics between patients who enrolled and those who did not. Enrollment was not associated with post-operative complication rate. Patients activated the pathway a median of 26 days (19-36) before their operation. They received a median of 23 emails (22, 30), 14 surveys, and 6 questionnaires; only 8 patients did not complete any of the daily surveys (5.9%). Median pre-operative anxiety score was 51 (43-56) after peri-operative education, indicating little to no anxiety. Median score change in global QOL at the 2-year time-point was +17 (0, 21). The majority of eligible patients enrolled in the pathway and patient satisfaction was high. There were no differences in post-operative complications based on enrollment. Enrolled patients had low pre-operative anxiety following peri-operative education and clinically significant QOL improvement at 2 years.