Enhancing postoperative care in rural Uganda: evaluating a Recovery@Home mobile health program's impact on ambulatory surgery outcomes.

BACKGROUND

In low- and middle-income countries, postoperative care for basic surgeries, such as hernia repairs, soft tissue excisions, and low-acuity gynecologic surgeries often involves prolonged hospitalization due to concerns about potential postoperative complications at home. An ambulatory surgical center in rural Uganda developed Recovery@Home, a mobile health program enabling home-based recovery with nurse-led monitoring/interventions.

METHODS

Recovery@Home uses a mobile app and visiting nurses for postoperative assessment and intervention through structured phone calls on postoperative day (POD) 1, home visits on POD 3 and 7, and follow-up calls on POD 14 and 30. This cross-sectional study, conducted from January to May 2024, compared outcomes among full, partial, and non-completers of the program. Descriptive statistics and multivariable logistic regression assessed the association between program adherence and postoperative outcomes, including wound complications, readmissions, second surgeries, and visits to other facilities within 30 postoperative days.

RESULTS

Among 234 patients, 54.3% (N = 127) were hernia repair, 21.8% (N = 51) were soft tissue/tumor excisions, 4.7% (N = 11) were gynecologic surgeries, and 19.2% (N = 45) were other low-acuity surgeries. A total of 166 (70.9%) fully completed the program, 50 (21.9%) partially completed it, and 18 (7.7%) did not participate. By POD30, 12.4% of patients experienced at least one complication, defined as a wound complication, readmission, second operation, or sought care elsewhere. Wound complications occurred in 9.0% and were defined as ≥ 2 signs of inflammation requiring additional physician assessment. Full program completion was associated with lower odds of wound complications (OR 0.121, 95% CI [0.034, 0.422], p < 0.001) and overall complications compared to non-completers (OR 0.170, 95% CI [0.055, 0.524], p = 0.002). On POD3, patients with high psychosocial/environmental risk factors (poor medication adherence, social support, hygiene) had increased risk for complications. Among them, 35% received nurse-led education, which significantly reduced wound complications (OR 0.042, 95% CI [0.002, 0.843], p = 0.038).

CONCLUSION

Recovery@Home demonstrates that a mobile health-driven approach can reduce risk of wound complications and overall complications in rural Uganda. Full program adherence and targeted early interventions are crucial for optimizing postoperative outcomes after ambulatory surgery.