Abstract
The purposes of this pilot study are to utilize digital remote monitoring to (a) evaluate the usability and satisfaction of a wireless blood pressure (BP) and heart rate (HR) monitor and (b) determine whether these data can enable safe mobilization at home after same-day discharge (SDD) joint replacement. A population of 23 SDD patients undergoing unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), or total hip arthroplasty (THA) were given a cellular BP/HR monitor, with real-time data capture. Patients took three readings after surgery, observing for specific blood pressure decreases, HR increases, or hypotensive symptoms. If any criteria applied, patients followed a hydration protocol and delayed ambulation. Home coaching was also provided to each patient. Patient experience was surveyed, and responses were assessed using descriptive statistics. Of 18 patients discharged (78%), 17 returned surveys, of which 100% reported successful device operation. The mean “ease of use” rating was 8.9/10; satisfaction with home coaching was 9.7/10; and belief that the protocol improved patient safety was 8.4/10. A total of 27.8% (n = 5) had hypotensive readings and appropriately delayed ambulation. Our pilot findings support the feasibility of and confirm the satisfaction with remote monitoring after SDD arthroplasty. All patients with symptoms of hypotension were successfully remotely managed using a standardized hydration protocol prior to safe mobilization.
Highlights
The predominance of growth in volume of total joint arthroplasty (TJA) procedures over the five years is expected in the outpatient setting [1]
Inpatient TJA has variable length of stay (LOS), with, at minimum, an overnight hospital stay [2], same-day discharge (SDD), or outpatient TJA, enables patients to be discharged on the very day of surgery after stabilization criteria have been met [3,4,5]
The exclusion criteria for SDD included any of the following medical conditions: diagnosis of COPD; chronic kidney disease with eGFR < 60; uncontrolled Type 2 diabetes or insulin-dependent diabetes mellitus; diagnosis of CHF or CAD and ratio of triglycerides/HDL > 4; more than two medications used for hypertension; history of stroke, deep vein thrombosis (DVT), pulmonary embolism (PE) or use of chronic anticoagulation; patient not opioid-naïve; movement disorder or inability to stand on one leg as determined by physical therapy; obstructive sleep apnea with or without continuous positive airway pressure therapy (CPAP); excessive anxiety with regard to going home
Summary
The predominance of growth in volume of total joint arthroplasty (TJA) procedures over the five years is expected in the outpatient setting [1]. Complications, readmission rates, and patient-reported outcomes are approximately the same in outpatient vs inpatient TJA when appropriate patient eligibility criteria are followed [7,8,9,10,11,12]. Additional inpatient care does not necessarily lead to improved outcomes; at-home recovery with appropriate pain management, outpatient physical therapy, and escalation pathways (as needed) are just as efficacious in certain patients. Concurrent to this outpatient shift is a growing interest in web-based platforms for follow-up assessments, patient education, seamless communication, and coaching. In SDD arthroplasty, there is significant opportunity to utilize these digital health tools to optimize post-operative recovery for patients at home. Before launching initiatives that incorporate digital health technology, appropriate diligence must be taken to understand the patient experience, predict barriers to adoption, and validate efficacy
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