Abstract
BackgroundWe conducted a prospective observational study of patients undergoing elective primary hip or knee replacements to examine the feasibility of a postoperative home monitoring system as transitional care to support patients following their surgery in real time.ObjectiveThe primary outcome was the mean percentage of successful wireless transmissions from home of blood pressure levels, heart rate, oxygen saturation levels, and pain scores until postoperative day 4 with a feasibility target of ≥90%.MethodsPatients with an expected length of stay ≤1 day, age 18-80 years, Revised Cardiac Risk Index ≤ class 2, and caretakers willing to assist at home were eligible. Patient satisfaction, as a secondary outcome, was also evaluated. Wireless monitoring equipment (remote patient monitoring, Telus Canada) was obtained and a multidisciplinary care team was formed.ResultsWe conducted the study after obtaining Research Ethics Board approval; 54 patients completed the study: 21 males, 33 females. In total, we evaluated 9 hips, 4 hip resurfacing, 26 total knees, and 15 hemi-knees. The mean transmission rate was 96.4% (SD 5.9%; 95% CI 94.8-98.0). The median response to “I would recommend the Remote Monitoring System program to future patients” was 4.5 (interquartile range 4-5), with 1 being “strongly disagree” and 5 “strongly agree.” At 30 days postop, there was no mortality or readmission.ConclusionsThis is an evolving new paradigm for postoperative care and the first feasibility study on monitoring biometrics after primary hip or knee replacement. Postoperative home monitoring combines current technology with real-time support by a multidisciplinary transitional care team after discharge, facilitating postsurgical care with successful wireless transmission of vitals. The postoperative home monitoring implementation is, therefore, generalizable to other surgical discharges from hospitals.Trial RegistrationClinicalTrials.gov NCT02143232; https://clinicaltrials.gov/ct2/show/NCT02143232 (Archived by WebCite at http://www.webcitation.org/71ugAhhIk)
Highlights
BackgroundFor a number of reasons, including the impetus to increase surgical throughput, the median length of stay in Canada has been decreased from 6 days in 2006-2007 to 4 days in 2012-2013 for total hip replacements and from 5 days in 2006-2007 to 3 days in 2013-2014 for total knee replacements [1,2]
The objectives of this study were to demonstrate the feasibility of wireless home monitoring after elective primary hip or knee replacements with a primary feasibility target of ≥90% successful transmission of blood pressure (BP) levels, heart rate (HR), and SpO2 levels and to collect pain scores 4 times a day from home until postoperative day (POD) 4
Approval from the Ottawa Hospital Research Ethics Board was obtained for a prospective observational study (NCT02143232) of patients undergoing elective primary hip or knee replacements with an expected length of stay ≤1 day, age between 50 and 80 years, Revised Cardiac Risk Index ≤Class 2, and caretakers to assist at home
Summary
BackgroundFor a number of reasons, including the impetus to increase surgical throughput, the median length of stay in Canada has been decreased from 6 days in 2006-2007 to 4 days in 2012-2013 for total hip replacements and from 5 days in 2006-2007 to 3 days in 2013-2014 for total knee replacements [1,2]. In one study in the United States, the 30-day readmission rate after total knee replacement was reported to be 5.6% [5]. The 30-day complication rate after hip or knee replacement was reported to be 2%, with complications including myocardial infarctions, deep vein thrombosis, pulmonary embolism, and death [6]. It is important to note the corollary that 98% of patients did not have complications and that 95.4% were not readmitted within 30 days of hip or knee replacements. We conducted a prospective observational study of patients undergoing elective primary hip or knee replacements to examine the feasibility of a postoperative home monitoring system as transitional care to support patients following their surgery in real time
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