Frumkin MR, Messner GR, Holzer KJ, et al. Remote perioperative symptom monitoring through a smartphone is feasible: evidence from the Personalised Prediction of Persistent Postsurgical Pain (P5) study. Br J Anaesth. 2026;doi:10.1016/j.bja.2026.03.066
The Personalized Prediction of Persistent Postsurgical Pain (P5) study is a single-center, prospective study designed to evaluate whether multimodal data, including ecological momentary assessment (EMA), improve the prediction of persistent postsurgical pain. This secondary analysis examined EMA compliance within a large surgical cohort. The P5 EMA consisted of 15 items administered three times daily, for which participants were not compensated. This analysis included 2329 participants, 67% (n=1555) female. Participants primarily identified as White or Caucasian (n=1752, 75.2%) or Black or of African heritage (n=427, 18.3%). Ninety percent of participants (n=2100) completed some preoperative or postoperative EMA assessment, and the average EMA response time was 89 seconds (median 65 seconds). On average, participants who did not complete any EMA assessments were older (median age of 58.6 years compared with 54.2 years among participants who completed EMA), and they were more likely to have governmentally subsidized insurance such as Medicaid. Preoperative EMA compliance did not differ by surgical site, although postoperative compliance varied across surgical procedures. Patients undergoing vascular and cardiothoracic procedures demonstrated below-average postoperative compliance, with mean compliance rates ranging from 49% to 51%. Additional factors correlated with EMA compliance. Preoperative pain catastrophizing showed the strongest association with both preoperative (r= -0.11, P.adj <0.001) and postoperative (r= -0.17, P<0.001) EMA compliance. Lower compliance was also associated with identifying as Black or of African heritage, using governmentally subsidized insurance, and having lower educational attainment. Exploratory analyses found no evidence that more frequent EMA participation worsened symptoms. Instead, participants completing more EMAs showed mild improvements in preoperative anxiety. Overall, the findings support the feasibility of perioperative EMA in a large surgical cohort.