Remote symptom monitoring with clinical alerts following lumpectomy: do alerts predict 30-day re-operation or re-admission rates?

[PURPOSE] Electronic patient-reported outcomes (ePROs) are used postoperatively to detect complications through real-time symptom monitoring. This study examines whether alerts triggered through the "Recovery Tracker" (RT), an ePRO system, predict 30-day re-admission or re-operation after lumpectomy.

[METHODS] We retrospectively reviewed breast cancer patients who underwent lumpectomy at a single institution between August 2018 and May 2024. Patients who completed RT surveys on postoperative days 1-5 were included. Symptom alerts categorized as red (urgent) and yellow (less urgent) were analyzed using generalized additive and univariable logistic regression models.

[RESULTS] Among 8723 included patients, 2552 (29%) triggered at least one alert. Yellow alerts were more common than red across all days. Most red alerts were related to pain or vomiting; most yellow alerts were related to pain or wound redness. Overall, symptom severity and interference decreased over time. Triggering an alert was associated with increased risk of 30-day re-admission or re-operation (odds ratio [OR] 2.86, 95% confidence interval [CI] 1.64-5.03; p < 0.001). However, absolute event rates were low (re-admission 0.3%, re-operation 0.2%), and the absolute risk increase associated with any alert was minimal (0.7%, 95% CI 0.2%-1.1%).

[CONCLUSION] Although triggering at least one ePRO alert is associated with an increased relative risk for re-admission or re-operation, the absolute risk increase of re-admission and re-operation is very small. With enhanced follow-up by the clinical team among patients who trigger an alert, patients can be reassured that most symptoms will resolve on their own or can be treated with outpatient intervention.