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Remote Symptom Monitoring with Clinical Alerts Following Mastectomy: Do Early Symptoms Predict 30-Day Surgical Complications

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Electronic patient-reported outcome measures (ePROMs) for real-time remote symptom monitoring facilitate early recognition of postoperative complications. We sought to determine whether remote, electronic, patient-reported symptom-monitoring with Recovery Tracker predicts 30-day readmission or reoperation in outpatient mastectomy patients.

Methods

We conducted a retrospective review of breast cancer patients who underwent outpatient (< 24-h stay) mastectomy with or without reconstruction from April 2017 to January 2022 and who received the Recovery Tracker on Days 1–10 postoperatively. Of 5,130 patients, 3,888 met the inclusion criteria (2,880 mastectomy with immediate reconstruction and 1,008 mastectomy only). We focused on symptoms concerning for surgical complications and assessed if symptoms reaching prespecified alert levels—prompting a nursing call—predicted risk of 30-day readmission or reoperation.

Results

Daily Recovery Tracker response rates ranged from 45% to 70%. Overall, 1,461 of 3,888 patients (38%) triggered at least one alert. Most red (urgent) alerts were triggered by pain and fever; most yellow (less urgent) alerts were triggered by wound redness and pain severity. The 30-day readmission and reoperation rates were low at 3.8% and 2.4%, respectively. There was no statistically significant association between symptom alerts and 30-day reoperation or readmission, and a clinically relevant increase in risk can be excluded (odds ratio 1.08; 95% confidence interval 0.8–1.46; p = 0.6).

Conclusions

Breast cancer patients undergoing mastectomy with or without reconstruction in the ambulatory setting have a low burden of concerning symptoms, even in the first few days after surgery. Patients can be reassured that symptoms that do present resolve quickly thereafter.

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Funding

Dr. Carlsson has received an honorarium and travel reimbursement from Ipsen as a consultant for Prostatype Genomics. Dr. Mehrara is the recipient of investigator-initiated research awards from Regeneron Corp, Atyr, Integra, and Pfizer and royalty payments from PureTech and is a consultant with Mediflix Corp. Dr. Stern is founder of MirrorMe3D with equity interest. Dr. Pusic is a codeveloper of the BREAST-Q, which is owned by Memorial Sloan Kettering Cancer Center. She receives a portion of the licensing fees (royalty payments) when the BREAST-Q is used in industry-sponsored clinical trials. Dr. Nelson is a consultant for RTI surgical. For the remaining authors, no conflicts of interest were declared. This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748, which funds the research infrastructure at Memorial Sloan Kettering Cancer Center.

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Author notes

  1. Jacqueline J. Chu and Audree B. Tadros have equally contributed to this work.

Authors and Affiliations

  1. Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jacqueline J. Chu MD, MS, Perri S. Vingan BS, Babak J. Mehrara MD, Carrie S. Stern MD & Jonas A. Nelson MD, MPH

  2. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Audree B. Tadros MD & Monica Morrow MD

  3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Melissa J. Assel MS, Andrew J. Vickers PhD & Sigrid Carlsson MD, PhD, MPH

  4. Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Taylor M. McCready MPH

  5. Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Sigrid Carlsson MD, PhD, MPH

  6. Department of Urology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden

    Sigrid Carlsson MD, PhD, MPH

  7. Department of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Andrea L. Pusic MD

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  1. Jacqueline J. Chu MD, MS
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Correspondence to Jonas A. Nelson MD, MPH.

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Chu, J.J., Tadros, A.B., Vingan, P.S. et al. Remote Symptom Monitoring with Clinical Alerts Following Mastectomy: Do Early Symptoms Predict 30-Day Surgical Complications. Ann Surg Oncol 31, 3377–3386 (2024). https://doi.org/10.1245/s10434-024-15031-3

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