Remote Perioperative Symptom Monitoring via Smartphone: A largescale feasibility analysis

Ecological momentary assessment (EMA) holds promise for perioperative monitoring, yet large-scale feasibility data are lacking. The Personalized Prediction of Persistent Postsurgical Pain (P5) study enrolled 2,500 adults undergoing major surgery at a single center. EMA consisting of 15 items was administered three times daily via smartphone. Participants were not directly incentivized for EMA compliance nor excluded for non-compliance. Approximately 90% of participants completed at least some EMA. Average preoperative compliance was 66% (Median=79%) and average postoperative compliance was 60% (Median=71%) in the first 30 days after surgery. Postoperative compliance differed by surgical site, with lowest compliance among vascular and cardiothoracic patients. Demographic characteristics, including race, insurance status, and education, were associated with compliance. Overall, perioperative EMA appears feasible. Appropriate handling of missing data is critical to ensure models are generalizable to individuals who hold marginalized identities.