Conference Coverage

Targeted Messaging Enhances Prehabilitation Benefits, Reduces Postoperative Complications Among Patients Following Plastic Surgery

Kate Young

Key Highlights

  • High patient engagement with a targeted messaging platform (TWISTLE) significantly reduced postoperative complications.
  • Patients in the top quartile of TWISTLE engagement had an odds ratio of 0.18 for complications compared with patients who had lower engagement.
  • Integration of digital messaging with prehabilitation programs can enhance compliance and surgical outcomes.

A study presented at the American Society of Plastic Surgeons demonstrated that patients who had plastic surgery and engaged most with the targeted messaging platform (TWISTLE) as part of the Indiana University Health Pre-Operative Wellness and Enhanced Rapid Recovery (POWERR) Program experienced significantly fewer postoperative complications compared with patients who had lower engagement. Patients with high TWISTLE engagement achieved an odds ratio of 0.18 for developing complications within 30 days compared with those in the lowest engagement quartile.

Enhanced recovery after surgery (ERAS) protocols have limitations, particularly in complex procedures like plastic surgery, which carry elevated complication risks. To address these gaps, the POWERR program was developed, offering a comprehensive set of prehabilitation interventions, including nutritional optimization, smoking cessation, Methicillin-resistant Staphylococcus aureus (MRSA) decolonization, and pulmonary and physical conditioning. Patient adherence to such pathways remains critical, and prior evidence shows that digital messaging can reinforce compliance.

This analysis included 141 patients undergoing plastic surgery procedures between 2020 and 2024. TWISTLE engagement was measured by message-opening behavior and used as a surrogate for patient compliance. Patients with no engagement were excluded. Those who interacted with messages were stratified into quartiles, and postoperative outcomes were assessed using the IU Health National Surgical Quality Improvement Program database. Multivariable logistic regression examined the relationship between engagement level and complications within 30 days.

No significant differences were observed across quartiles 1 to 3. However, patients in the top quartile of TWISTLE engagement demonstrated significantly fewer postoperative complications, with a protective odds ratio of 0.18 (P = .0499; 95% CI, 0.03-1.00). This suggests that higher patient engagement with prehabilitation reminders translated into measurable improvements in surgical outcomes.

“The implications of our data suggest that the messaging platform ‘TWISTLE’ in providing patients with time-sensitive reminders to complete each step of the POWERR pathway yields an added benefit in reducing postoperative complications among all plastic surgery patients enrolled in the POWERR plan,” the study authors concluded. “Our work contributes to the ongoing discussion on surgical optimization and its role in decreasing preventable adverse events within our specialty.”

Reference:
Corpuz G, Kilbane E, Kim D, Waljee J, Wooden W. Improving surgical outcomes through the synergistic effects combining a hospital-wide prehabilitation program and targeted messaging campaign: A NSQIP study. Presented at: Presented at: American Society of Plastic Surgeons; October 9-12, 2025; New Orleans, Louisiana. https://www.plasticsurgerythemeeting.com/