Relationship Between Mobile Digital Sensor Monitoring and Perioperative Outcomes: Systematic Review

Abstract

Background Monitoring surgical recovery has traditionally been confined to metrics measurable within the hospital and clinic setting. However, commercially available mobile sensors are now capable of extending measurements into a patient’s home. As these sensors were developed for nonmedical applications, their clinical role has yet to be established. The aim of this systematic review is to evaluate the relationship between data generated by mobile sensors and postoperative outcomes. Objective The objective of this study is to describe the current use of mobile sensors in the perioperative setting and the correlation between their data and clinical outcomes. Methods A systematic search of EMBASE, MEDLINE, and Cochrane Library from inception until April 2019 was performed to identify studies of surgical patients monitored with mobile sensors. Sensors were considered if they collected patient metrics such as step count, temperature, or heart rate. Studies were included if patients underwent major surgery (≥1 inpatient postoperative day), patients were monitored using mobile sensors in the perioperative period, and the study reported postoperative outcomes (ie, complications and hospital readmission). For studies including step count, a pooled analysis of the step count per postoperative day was calculated for the complication and noncomplication cohorts using mean and a random-effects linear model. The Grading of Recommendations, Assessment, Development, and Evaluation tool was used to assess study quality. Results From 2209 abstracts, we identified 11 studies for review. Reviewed studies consisted of either prospective observational cohorts (n=10) or randomized controlled trials (n=1). Activity monitors were the most widely used sensors (n=10), with an additional study measuring temperature, respiratory rate, and heart rate (n=1). Low step count was associated with worse postoperative outcomes. A median step count of around 1000 steps per postoperative day was associated with adverse surgical outcomes. Within the studies, there was heterogeneity between the type of surgery and type of reported postoperative outcome. Conclusions Despite significant heterogeneity in the type of surgery and sensors, low step count was associated with worse postoperative outcomes across surgical specialties. Further studies and standardization are needed to assess the role of mobile sensors in postoperative care, but a threshold of approximately 1000 steps per postoperative day warrants further investigation.

The Effect of Postoperative Mobilization with a Pedometer on Pulmonary Functions and Length of Postoperative Hospital Stay in Patients Undergoing Lung Resection: Cross-Sectional Study

“…6 In their systematic review, Memon et al revealed that the low daily step count (1,000 step) adversely affected surgical outcomes. 11 Kavurmaci et al showed that the step count below 2,513 on the 1 st postoperative day in patients who underwent lung resection other than pneumonectomy was associated with prolonged air leak. 10 Takahashi et al showed that the daily mean step count threshold of 1,308 steps in patients who were rehospitalized for cardiac reasons after cardiac surgery was a risk factor.…”

“…9 Studies have demonstrated an association between physical activity and length of hospital stay and surgical outcomes. 6,10,11 However, studies revealing the effect of postoperative physical activity on early lung capacity are limited. 12 This study aims to determine the effect of postoperative mobilization with a pedometer on pulmonary functions and length of postoperative hospital stay in patients undergoing lung resection and secondarily to evaluate the effect of pedometer use on patient satisfaction.…”

Definition and Classification of Postoperative Complications After Cardiac Surgery: Pilot Delphi Study

“…It is therefore essential that efforts should be "directed to further reducing morbidity and length of stay" [2] and that adequate systems are developed to better predict, anticipate, plan, and mitigate the risks for severe surgical complications. Although efforts are made to preempt postoperative complications in cardiac surgery using various technologies [9][10][11], the lack of a consensual and standard definition and classification of postoperative complications in cardiac surgery, however, acts as an important barrier to developing adequate monitoring and reporting systems for cardiac surgery complications [12].…”