Smartphone-Based Monitoring of Quality of Life and Adverse Events After Neurosurgery: Prospective Cohort Study.

Abstract

Postoperative outcome assessment is often based on discrete follow-up visits, limiting characterization of individual recovery trajectories, and the timely identification of adverse events (AEs). Longitudinal smartphone-based monitoring may overcome these limitations by enabling frequent, resource-efficient collection of patient-reported outcomes and complications throughout recovery. Such data may provide a more patient-centered understanding of the postoperative course and complement conventional clinical surveillance. This study aimed to evaluate the feasibility of smartphone-based longitudinal monitoring of quality of life, subjective well-being, and AEs after elective neurosurgery and compare postoperative recovery trajectories and agreement between patient- and clinician-reported AEs. This interim analysis of a prospective cohort study included adult patients undergoing elective lumbar decompression, lumbar fusion, supratentorial craniotomy, or infratentorial craniotomy at a Swiss tertiary referral center between June 2023 and January 2025. Participants used a smartphone app to longitudinally report subjective well-being (Subjective Well-Being Index; 0-10), quality of life (EQ-5D-5L), and AEs for up to 1 year postoperatively. Complications were self-reported using the Therapy-Disability-Neurology (TDN) classification and retrospectively adjudicated by physicians. Descriptive analyses assessed data density, engagement, and concordance between patient- and clinician-reported events. Mixed-effects models were used to evaluate factors associated with postoperative well-being. Of the 100 enrolled patients (median age 64.0, IQR 52.95-71.6 years; n=45, 45% women), 86 (86%) provided postoperative data. During a median follow-up of 3.2 (IQR 0.2-11.3) months, participants submitted 4354 longitudinal well-being entries. Patients reported 22 unique AEs, whereas physicians identified 44 AEs, with overlap for 9 (20.5%) events. Most physician-reported AEs were mild (30/44, 68.2%; TDN grade 1-2), and no grade 4 or 5 events occurred. Patient-reported AEs primarily reflected symptomatic and functional impairments, whereas physician-reported events more often included clinically detected or subclinical findings. In mixed-effects models, time since surgery was associated with improved well-being, and no other factors were statistically significant. Smartphone-based postoperative monitoring was feasible in this elective neurosurgical cohort and generated dense longitudinal patient-reported data beyond routine follow-up. Patient and clinician AE reporting captured partly distinct aspects of postoperative recovery, suggesting that smartphone-based self-reporting may complement rather than replace clinical surveillance.