Usability and outcomes of self-monitored surgical wound healing using a smartphone-based application by patients following neurosurgery

C van Rossum; K de Bree; G de Jong; R Bartels; G Heeren; M Nabuurs; C Meijer; A Tostmann; R Aquarius

doi:10.1016/j.jhin.2024.03.011

Usability and outcomes of self-monitored surgical wound healing using a smartphone-based application by patients following neurosurgery

J Hosp Infect. 2024 Mar 28:148:138-144. doi: 10.1016/j.jhin.2024.03.011. Online ahead of print.

Authors

C van Rossum¹, K de Bree², G de Jong³, R Bartels², G Heeren⁴, M Nabuurs⁴, C Meijer⁵, A Tostmann⁶, R Aquarius⁷

Affiliations

¹ Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands. Electronic address: Carsten.vanrossum@radboudumc.nl.
² Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Neurosurgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands.
³ Department of Oral & Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
⁴ Department of Medical Microbiology and Immunology, Dicoon/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
⁵ Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
⁶ Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands; Regional Antimicrobial Resistance and Infection Prevention Network Gelderland, Radboud University Medical Centre, Nijmegen, The Netherlands.
⁷ Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands.

PMID: 38554806
DOI: 10.1016/j.jhin.2024.03.011

Abstract

Background: The Radboudumc developed a smartphone application (WondGezond) to collect surgical wound-healing information provided by the patient.

Aim: To evaluate usability and outcomes to assess its potential for early surgical site infection (SSI) detection.

Methods: Patients surgically treated for degenerative spinal disorders or carpal tunnel syndrome between August 2020 and February 2023 were enrolled one day post surgery and asked to download the app via a quick-response (QR) code. Participants uploaded a photo and answered four questions about their wound daily, for 14 days. Afterwards, participants indicated whether they received treatment for a suspected SSI (participant-reported outcome). Two neurosurgeons independently assessed photos and questionnaire answers for suspected SSIs (physician-assessed outcome). The association between both outcomes was determined by calculating sensitivity, specificity, and positive and negative predictive value (PPV/NPV).

Findings: After 2009 surgeries, 1695 QR-codes were distributed and 412 (21%) were activated. In all, 232 (56%) participants completed the 14-day period of whom 22 (10%) reported SSI treatment. Physician assessment identified 15 (7%) SSIs. Concordance was reached in 88% of cases. Among 27 discordant cases were 17 false-positives and 10 false-negatives, resulting in low sensitivity (33%) and PPV (23%), but high NPV (95%).

Conclusion: WondGezond provides clinicians with information regarding wound healing and SSIs to follow-up on patients at risk, while possibly also reducing antibiotic (over)treatment and unnecessary visits for patients without issues in wound healing. However, the low participation and false-positive results render the app in its current form unsuitable for surveillance purposes. Further validation of WondGezond is required.

Keywords: Patient-reported outcome measures; Smartphone; Surgical wound infection; Surveillance.