Regionalized Surgical Care: Public Perspective And A Novel Mobile Health Intervention

Other Titles


Background: The relationship between high surgical volume and improved perioperative outcomes has been well documented in many contexts. This finding has led to efforts to regionalize surgical care, restricting complex elective surgery to centers with high volume. The process of regionalizing care has proceeded largely without exploring what barriers patients experience when attempting to access such high-volume surgical care. Additionally, there is a lack of interventions available to improve patient recovery during the immediate postoperative period. We sought to identify the public’s perceived barriers to regionalized surgical care, and to create a smartphone based mobile health application that could be used to speed recovery of patients immediately after surgery. Such an application could be used by patients regardless of their distance from a regional center. Methods: We participated in the Cornell National Social Survey, a random-digit-dial telephone survey of 1000 households in the United States. Participants answered questions about their willingness to seek regionalized care in a hypothetical scenario requiring elective abdominal surgery for cancer. We compared their responses and demographic characteristics. We also performed a geospatial analysis of respondent proximity to hospitals, and a qualitative analysis of perceived barriers to regionalization. To test an intervention to improve regionalized care, we performed a pilot study of a novel mobile health application in adults undergoing major abdominal surgery. Patients undergoing colorectal surgery were recruited from a single center. They were given the mobile health app, and used it to report their pain, answer surveys, and photograph their wound. They were periodically reminded to stay hydrated, and used a Fitbit™ device to track their mobility. Concerning responses triggered alerts for further evaluation. Patients were followed postoperatively for 30 days and compliance with app use was tracked. Results: Cooperation rate was 48.1% in the household survey. Survey participants were average 50 years old and 48.9% female. 49.6% stated unwillingness to travel five hours or more to seek regionalized care for improved survival. Age >70yo (OR 0.34 95% CI 0.19-0.60) and perceived travel to a center >30 minutes (OR 0.60 95% CI 0.41-0.86) were associated with decreased willingness to seek regionalized care, while high income (OR 2.09 95% CI 1.39-3.16) was associated with increased willingness. Proximity to a major center was not associated with willingness to travel (OR 0.92 95% CI 0.67-1.22). 6 major perceived barriers to regionalization were identified including: transportation, life disruption, social support, socioeconomic resources, poor health, and remoteness. For the mobile app intervention portion of the study, 31 patients undergoing colorectal surgery participated. Most were female (58%), and white (61%). 19% had an ostomy as part of their surgery. 83.9% of patients completed at least 70% of the app-related tasks they were given. 89% said using the app was easy to use. Patients generated an average of 1.1 alerts. One patient was readmitted and generated 7 alerts prior to re-admission. Patients participated most in collecting Fitbit data (84.8% of days) and completing a single-item photoaffective meter, but had more difficulty uploading photographs (51.4% completed). 89% of patients found the application easy to use. Conclusions: Americans are divided on whether the potential for improved survival with regionalization is worth the additional travel effort. Older patients and those with lower income are less willing to travel for regionalized care. However, the travel burden of regionalized care might be reduced with mobile health technology. It is feasible to use a novel mobile health app to monitor patient recovery from major abdominal surgery. The app is easy to use, and has the potential to improve outcomes. Patients can use this app regardless of their proximity to a high-volume center.

Journal / Series

Volume & Issue



Date Issued




Colorectal surgery; Mobile Applications/utilization; Qualitative Research; readmission; Surgery; telemedicine


Effective Date

Expiration Date




Union Local


Number of Workers

Committee Chair

Committee Co-Chair

Committee Member

Degree Discipline

Clinical Epidemiology & Health Services Research

Degree Name

Degree Level

Master of Science

Related Version

Related DOI

Related To

Related Part

Based on Related Item

Has Other Format(s)

Part of Related Item

Related To

Related Publication(s)

Link(s) to Related Publication(s)


Link(s) to Reference(s)

Previously Published As

Government Document




Other Identifiers


Attribution-NonCommercial-NoDerivatives 4.0 International


dissertation or thesis

Accessibility Feature

Accessibility Hazard

Accessibility Summary

Link(s) to Catalog Record