Incorporating mobile technology into postoperative care: a shift in paradigm toward ambulatory surgery in Uganda

TITLE: Incorporating mobile technology into postoperative care: a shift in paradigm toward ambulatory surgery in LMIC. PROJECT SUMMARY In many low- and middle-income countries (LMICs), low-acuity surgeries require postoperative hospitalization for several days, partly due to concerns of inadequate follow-up after discharge and partly to cultural norms. This not only poses increased risks of hospital acquired complications, but also increases the total surgical costs for both patients and facilities. Consequently, this inefficient practice contributes to the barriers to access safe and affordable surgical care. We propose an alternate approach of mHealth Ambulatory Surgery with Follow-up Nurse (mAS-FUN), which does not require patient hospitalization after surgery. Since 2020, we have implemented mAS-FUN at the Kyabirwa Surgical Center (KSC), the first ambulatory surgery center in rural Uganda. The current proposal aims to show mAS-FUN is safe, effective, and markedly reduces costs when patient follow-ups can be reliably performed at home via a cloud-based mobile app and visiting nurse. Based on our robust preliminary data, our central hypothesis is that implementation of mAS-FUN reduces hospital and patient costs, improves patient follow-up, and reduces recovery time, without increasing complications, compared to the current inpatient practice in other surgical facilities across Uganda. In our preliminary work, we have established the framework for mAS-FUN at KSC, including hiring key personnel and testing study protocols. In the R21 phase, we will perform a prospective, observational clinical study aimed at validating the safety, feasibility, acceptability of mAS-FUN for the primary outcomes of costs for both patients and facilities, whether patients can be assessed after discharged home, and total duration of postoperative medical care received; and the secondary outcomes of postoperative complications, time to functional recovery and ability to return to work, and acceptability of mAS-FUN by patients, healthcare personnel, and the community, as compared to historical controls. Armed with strong partnerships and adequate preparation during the R21 phase, we will then perform a stratified cluster randomized, controlled clinical trial during the R33 phase, comparing the novel mAS-FUN versus traditional approaches at three surgical centers in Uganda. Demonstrating the feasibility, acceptability, and effectiveness of this novel approach for surgical care – and its ability to improve outcomes – is necessary for wide-spread adoption. We expect our findings will ultimately shift the paradigm of how surgery for low-acuity procedures is practiced in Uganda and serve as a model for other LMICs.