Texting promotes recovery after breast reconstruction

Postoperative text communication with surgeon reduces visits, shortens fluid drainage time

June 29, 2012
American Society of Plastic Surgeons (ASPS)

For women undergoing breast reconstruction after mastectomy, text messaging between the patient and surgeon leads to improvements in some key postoperative outcomes, according to a study in the July issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

The study is the first to show potential benefits of text messaging between surgeons and patients undergoing a specific surgical procedure. The lead author was Dr. Roshni Rao of University of Texas Southwestern Medical Center, Dallas.

Texting helps routine follow-up after breast surgery

The study included 102 women undergoing breast reconstruction after mastectomy for treatment (or in some cases prevention) of breast cancer. The women were operated on by two similarly experienced surgeons using similar techniques. The only difference was that one surgeon used routine postoperative text messaging while the other did not. For the purposes of the study, matched groups of women with similar characteristics were selected.

In the text messaging group, patients texted the amount of fluid output from a surgical drain each evening, starting on the day they left the hospital. Drains are placed to eliminate excess fluid after breast reconstruction. Monitoring the amount of fluid and removing the drain when it is no longer needed are routine parts of follow-up care.

After receiving the patient's message, the surgeon responded with instructions to continue with standard drain care, or to come to the clinic for drain removal or wound evaluation on the next working day. Patients operated on by the other surgeon received a routine appointment to come to the clinic one week after leaving the hospital. Both groups had access to clinic phone numbers and an Internet patient care portal.

At follow-up, women who exchanged texts with their surgeon made significantly fewer clinic visits and phone calls. In the first 30 days, the average number of clinic visits was 2.82 in the text message group versus 3.65 in the usual care (no texting) group.

Text messaging also reduced the number of days the drain was needed. On average, the drain was removed nearly three days earlier in the text messaging group, and was more likely to be removed at the first clinic visit.

"Consistent with the benefits of text messaging (ease of use, speed, simplicity), patients' adherence to medical advice (monitoring and recording ... drain output) improved in this study," according to Dr. Rao and colleagues. Some patients mentioned that being able to communicate with their surgeon via text helped them feel "empowered and an advocate for their own care."

Despite potential advantages, texting as a means of interaction between doctors and patients has been slow to catch on. Obstacles include concerns about confidential patient information and the physicians' privacy. In the study, patients used text messaging to send only the requested information during specified hours, and messages only appeared on a password-protected cell phone.

Concerns about physician time and reimbursement for dealing with patient text messages have also limited the use of texting in clinical care. However, if routine postoperative text messages help to reduce unnecessary clinic visits - as in the new study - that's a clear time-saving advantage for surgeons.

Integration with electronic health records is a technological challenge that remains to be dealt with. In the meantime, Dr. Rao and coauthors write, "The results of this exploratory study are intriguing and may provide a strategy for innovative communication between physicians and patients."