Digital innovations and emerging technologies for enhanced recovery programmes

Abstract

Enhanced recovery programmes (ERPs) are increasingly used to improve post-surgical recovery. However, compliance to various components of ERPs-a key determinant of success-remains sub-optimal. Emerging technologies have the potential to help patients and caregivers to improve compliance with ERPs.Preoperative physical condition, a major determinant of postoperative outcome, could be optimized with the use of text messages (SMS) or digital applications (Apps) designed to facilitate smoking cessation, modify physical activity, and better manage hypertension and diabetes. Several non-invasive haemodynamic monitoring techniques and decision support tools are now available to individualize perioperative fluid management, a key component of ERPs. Objective nociceptive assessment may help to rationalize the use of pain medications, including opioids. Wearable sensors designed to monitor cardio-respiratory function may help in the early detection of clinical deterioration during the postoperative recovery and to address 'failure to rescue'. Activity trackers may be useful to monitor early mobilization, another major element of ERPs. Finally, electronic checklists have been developed to ensure that none of the above-mentioned ERP elements is omitted during the surgical journey.By optimizing compliance to the multiple components of ERPs, digital innovations, non-invasive techniques and wearable sensors have the potential to magnify the clinical and economic benefits of ERPs. Among the growing number of technical innovations, studies are needed to clarify which tools and solutions have real clinical value and are cost-effective.

Continuous vital sign monitoring after major abdominal surgery—Quantification of micro events

“…Similar to our study, technological advances now allow for continuous monitoring of vital parameters with so‐called wear‐and‐forget devices to assess the usability and compare them to conventional measurements …”

“…Post‐operative imbalance of oxygenation (either hypoxemia or supplemental oxygen resulting in hyperoxia) has been linked to several post‐operative cerebral, pulmonary and cardiac complications, and surgical site infections . However, our study was not powered to detect differences in clinical outcomes, but these must be considered in future larger trials to substantiate the effect of continuous monitoring and advocate for the initial increased expenses and continued research …”

Addressing the growing opioid and heroin abuse epidemic: a call for medical school curricula

“…The advantage of developing such technology is that biomonitoring and its relation to learning and cognitive load can now be accomplished through wearable wrist sensors. While this technological approach is very effective for the evaluation of learners in EI scenarios, the wearable wrist/digital technology is now being adopted and transitioned from the learner to the recovering addict leaving rehabilitation [51]. If consent is received from the individual, parties interested in the recovering addict’s wellbeing (family and health professionals) may monitor the individual’s physiological status (and even social inputs) with a built-in alerting ability linked to health professionals and emergency medical services (this is done through feed forward-back propagating neural networks where indicators can be converted into measurable outputs through development of a machine learning-based approach) [50].…”

Continuous Versus Intermittent Vital Signs Monitoring Using a Wearable, Wireless Patch in Patients Admitted to Surgical Wards: Pilot Cluster Randomized Controlled Trial (Preprint)

“…Clinical deterioration on general wards may remain undetected for hours before clinicians are alerted [3]. One solution may be continuous vital signs monitoring, which until now has been limited to use on critical care wards due to prohibitive cost and implications for patient mobility and recovery.…”

“…A number of such tools have already received the Food and Drug Administration (FDA) clearance, but clinical studies are required to demonstrate their clinical utility in the post-surgical setting [3,7].…”