Remote Perioperative Symptom Monitoring via Smartphone: A largescale feasibility analysis

Ecological Momentary Assessment (EMA) may be useful in the surgical setting for predicting and monitoring symptoms including perioperative pain. However, no largescale studies have established the feasibility of perioperative EMA. The Personalized Prediction of Persistent Postsurgical Pain (P5) study includes collection of perioperative EMA in a cohort of 2,500 patients who underwent major surgery in the Midwestern United States. Despite EMA not being required nor directly incentivized, 91% of participants completed any EMA. Demographic and clinical characteristics were largely similar between those who did and did not complete EMA, except for insurance status. Participants who did not complete any EMA were more likely to be using Medicare (38% vs. 28%) or Medicaid (20% vs. 11%). Without excluding participants based on low compliance, we observed high preoperative (Median = 80%) and postoperative (Median = 72%) compliance with EMAs delivered three times per day. Compliance was somewhat lower among individuals with worse mental and physical health symptoms, though effect sizes were small. Sociodemographic characteristics were associated with both pre- and postoperative EMA compliance, such that men who identified as Black/African heritage responded to fewer than 50% of surveys on average. Individuals who used Medicaid and those with lower educational attainment also exhibited lower compliance. Overall, EMA appears feasible in the surgical setting. However, knowledge of these disparities is critical to ensuring that EMA research is generalizable, as individuals who provide less data will be less influence in statistical models without proper handling of missing data.