Continuous remote monitoring in post–bariatric surgery patients: development of an early warning protocol

Ede, Elisabeth S. van; Scheerhoorn, Jai; Bonomi, A.; Buise, Marc P.; Bouwman, R. Arthur; Nienhuijs, Simon W.

doi:10.1016/j.soard.2022.06.018

Cited by 7 publications

(8 citation statements)

References 30 publications

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“…Novel wearable sensors allow for unobtrusive continuous monitoring of vital parameters, thereby allowing the monitoring of diurnal rhythm features as well. Recent publications imply that these sensors could provide an alternative for conventional EWS systems [ 14 , 32 ]. Similar to conventional EWS systems, continuous EWS systems focus on the identification of abnormal vital parameters such as brady- or tachycardia.…”

Section: Discussionmentioning

confidence: 99%

“…This hypothesis is supported by a study by Davidson et al, who were the first to study diurnal rhythms in continuous measurements of vital parameters in the ICU, where they described potential prognostic value for patient recovery [ 13 ]. New innovations, such as continuous monitoring using wearables, have been increasingly investigated and recent studies have shown the potential for deterioration detection in perioperative care [ 14 – 17 ]. While wearables allow for continuous monitoring of heart rate regardless of the state of consciousness and the patient’s location, the diurnal rhythm of heart rate during normal recovery and its potential impairment in complicated postoperative recovery remain unknown.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative circadian patterns in wearable sensor measured heart rate: a prospective observational study

Mestrom,

van der Stam,

Nienhuijs

et al. 2023

J Clin Monit Comput

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Purpose This study aimed to describe the 24-hour cycle of wearable sensor-obtained heart rate in patients with deterioration-free recovery and to compare it with patients experiencing postoperative deterioration. Methods A prospective observational trial was performed in patients following bariatric or major abdominal cancer surgery. A wireless accelerometer patch (Healthdot) continuously measured postoperative heart rate, both in the hospital and after discharge, for a period of 14 days. The circadian pattern, or diurnal rhythm, in the wearable sensor-obtained heart rate was described using peak, nadir and peak-nadir excursions. Results The study population consisted of 137 bariatric and 100 major abdominal cancer surgery patients. In the latter group, 39 experienced postoperative deterioration. Both surgery types showed disrupted diurnal rhythm on the first postoperative days. Thereafter, the bariatric group had significantly lower peak heart rates (days 4, 7–12, 14), lower nadir heart rates (days 3–14) and larger peak-nadir excursions (days 2, 4–14). In cancer surgery patients, significantly higher nadir (days 2–5) and peak heart rates (days 2–3) were observed prior to deterioration. Conclusions The postoperative diurnal rhythm of heart rate is disturbed by different types of surgery. Both groups showed recovery of diurnal rhythm but in patients following cancer surgery, both peak and nadir heart rates were higher than in the bariatric surgery group. Especially nadir heart rate was identified as a potential prognostic marker for deterioration after cancer surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Postoperative circadian patterns in wearable sensor measured heart rate: a prospective observational study

Mestrom,

van der Stam,

Nienhuijs

et al. 2023

J Clin Monit Comput

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“…Every five minutes, the mean of these values was transmitted and visualized in trend graphs in the Guardian Intellivue dashboard (Philips Electronic Nederland BV). A warning score was calculated for events with a heart rate and respiration rate above a pre-defined threshold of 110 beats per minute and 20 breaths per minute respectively [ 20 ]. These values were based on literature and clinical experience of the medical team.…”

Section: Methodsmentioning

confidence: 99%

Telemonitoring for perioperative care of outpatient bariatric surgery: Preference-based randomized clinical trial

et al. 2023

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Importance Implementation of bariatric surgery on an outpatient basis is hampered by concerns about timely detection of postoperative complications. Telemonitoring could enhance detection and support transition to an outpatient recovery pathway. Objective This study aimed to evaluate non-inferiority and feasibility of an outpatient recovery pathway after bariatric surgery, supported by remote monitoring compared to standard care. Design Preference-based non-inferiority randomized trial. Setting Center for obesity and metabolic surgery, Catharina hospital Eindhoven, the Netherlands. Participants Adult patients scheduled for primary gastric bypass or sleeve gastrectomy. Interventions Same-day discharge with one week ongoing Remote Monitoring (RM) of vital parameters or Standard Care (SC) with discharge on postoperative day one. Main outcomes Primary outcome was a thirty-day composite Textbook Outcome score encompassing mortality, mild and severe complications, readmission and prolonged length-of-stay. Non-inferiority of same-day discharge and remote monitoring was accepted below the selected margin of 7% upper limit of confidence interval. Secondary outcomes included admission duration, post-discharge opioid use and patients’ satisfaction. Results Textbook Outcome was achieved in 94% (n = 102) in RM versus 98% (n = 100) in SC (RR 2.9; 95% CI, 0.60–14.23, p = 0.22). The non-inferiority margin was exceeded which is a statistically inconclusive result. Both Textbook Outcome measures were above Dutch average (5% RM and 9% SC). Same-day discharge reduced hospitalization days by 61% (p<0.001) and by 58% with re-admission days included (p<0.001). Post-discharge opioid use and satisfaction scores were equal (p = 0.82 and p = 0.86). Conclusion In conclusion, outpatient bariatric surgery supported with telemonitoring is clinically comparable to standard overnight bariatrics in terms of textbook-outcome. Both approaches reached primary endpoint results above Dutch average. However, statistically the outpatient surgery protocol was neither inferior, nor non-inferior to the standard pathway. Additionally, offering same-day discharge reduces the total hospitalization days while maintaining patient satisfaction and safety.

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“…These analyses were performed with a subpopulation of Transitional Care Study 3 (TRICA; ClinicalTrials.gov NCT03923127)—a single-center study on wearable monitoring in postoperative patients in a tertiary hospital [ 17 , 18 ]. All adult patients scheduled for major abdominal oncological or bariatric surgery from April 2019 to August 2020 who were willing and able to sign informed consent were eligible for participation.…”

Section: Methodsmentioning

confidence: 99%

The Accuracy of Wrist-Worn Photoplethysmogram–Measured Heart and Respiratory Rates in Abdominal Surgery Patients: Observational Prospective Clinical Validation Study

Stam¹,

Mestrom²,

Scheerhoorn³

et al. 2023

JMIR Perioper Med

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Background Postoperative deterioration is often preceded by abnormal vital parameters. Therefore, vital parameters of postoperative patients are routinely measured by nursing staff. Wrist-worn sensors could potentially provide an alternative tool for the measurement of vital parameters in low-acuity settings. These devices would allow more frequent or even continuous measurements of vital parameters without relying on time-consuming manual measurements, provided their accuracy in this clinical population is established. Objective This study aimed to assess the accuracy of heart rate (HR) and respiratory rate (RR) measures obtained via a wearable photoplethysmography (PPG) wristband in a cohort of postoperative patients. Methods The accuracy of the wrist-worn PPG sensor was assessed in 62 post–abdominal surgery patients (mean age 55, SD 15 years; median BMI 34, IQR 25-40 kg/m2). The wearable obtained HR and RR measurements were compared to those of the reference monitor in the postanesthesia or intensive care unit. Bland-Altman and Clarke error grid analyses were performed to determine agreement and clinical accuracy. Results Data were collected for a median of 1.2 hours per patient. With a coverage of 94% for HR and 34% for RR, the device was able to provide accurate measurements for the large majority of the measurements as 98% and 93% of the measurements were within 5 bpm or 3 rpm of the reference signal. Additionally, 100% of the HR and 98% of the RR measurements were clinically acceptable on Clarke error grid analysis. Conclusions The wrist-worn PPG device is able to provide measurements of HR and RR that can be seen as sufficiently accurate for clinical applications. Considering the coverage, the device was able to continuously monitor HR and report RR when measurements of sufficient quality were obtained. Trial Registration ClinicalTrials.gov NCT03923127; https://www.clinicaltrials.gov/ct2/show/NCT03923127

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Continuous remote monitoring in post–bariatric surgery patients: development of an early warning protocol

Cited by 7 publications

References 30 publications

Postoperative circadian patterns in wearable sensor measured heart rate: a prospective observational study

Postoperative circadian patterns in wearable sensor measured heart rate: a prospective observational study

Telemonitoring for perioperative care of outpatient bariatric surgery: Preference-based randomized clinical trial

The Accuracy of Wrist-Worn Photoplethysmogram–Measured Heart and Respiratory Rates in Abdominal Surgery Patients: Observational Prospective Clinical Validation Study

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