Postoperative Remote Automated Monitoring: Need for and State of the Science

Abstract

Worldwide, more than 230 million adults have major noncardiac surgery each year. Although surgery can improve quality and duration of life, it can also precipitate major complications. Moreover, a substantial proportion of deaths occur after discharge. Current systems for monitoring patients postoperatively, on surgical wards and after transition to home, are inadequate. On the surgical ward, vital signs evaluation usually occurs only every 4-8 hours. Reduced in-hospital ward monitoring, followed by no vital signs monitoring at home, leads to thousands of cases of undetected/delayed detection of hemodynamic compromise. In this article we review work to date on postoperative remote automated monitoring on surgical wards and strategy for advancing this field. Key considerations for overcoming current barriers to implementing remote automated monitoring in Canada are also presented.

Vital Signs Monitoring with Wearable Sensors in High-risk Surgical Patients

“…The potential benefits of continuous remote wireless patient monitoring are increasingly recognized. 16,[42][43][44] A recent review by Downey et al 45 concluded that continuous monitoring outside critical care settings is feasible and may show patient benefits in terms of improved outcomes and cost efficiency. Another review suggested that implementation of remote monitoring with automated notifications increased involvement of ward physicians, rather than increased rapid response teams activation.…”

Insights into postoperative respiration by using continuous wireless monitoring of respiratory rate on the postoperative ward: a cohort study

“…However, the number and quality of studies was too low to allow final conclusions. Recent publications support the need for continuous ward monitoring [48,49], and several different systems are available, including new measurement techniques [50,51]. In the current study we demonstrated that with the used wireless monitoring system it is feasible to electronically measure RespR up to 4 days post-operatively on the ward.…”

Feasibility of remote digital monitoring using wireless Bluetooth monitors, the Smart Angel™ app and an original web platform for patients following outpatient surgery: a prospective observational pilot study

“…To our knowledge, the use of remote monitors for MAP, HR and SpO 2 has never been evaluated in ambulatory surgery. Similar systems have been extensively tested and evaluated in cardiology, oncology and diabetes [ 17 – 20 ]. In these cases, they have contributed to optimising remote medical monitoring and adapting treatments [ 20 ].…”

“…Similar systems have been extensively tested and evaluated in cardiology, oncology and diabetes [ 17 – 20 ]. In these cases, they have contributed to optimising remote medical monitoring and adapting treatments [ 20 ]. In this sense, after ambulatory surgery, these monitors may be effective in detecting early postoperative adverse events in patients at home.…”