Abstract
BackgroundDespite medical advances, major surgery remains high risk with up to 44% of patients experiencing postoperative complications. Early recognition of postoperative complications is crucial in reducing morbidity and preventing long-term disability. The current standard of care is intermittent manual vital signs monitoring, but new wearable remote monitors offer the benefits of continuous vital signs monitoring without limiting the patient’s mobility. The aim of this study was to evaluate the feasibility, acceptability and clinical outcomes of continuous remote monitoring after major surgery.MethodsThe study was a randomised, controlled, unblinded, parallel group, feasibility trial. Adult patients undergoing elective major surgery were randomly assigned to receive continuous remote monitoring and normal National Early Warning Score (NEWS) monitoring (intervention group) or normal NEWS monitoring alone (control group). Continuous remote monitoring was achieved using the SensiumVitals® wireless patch which is worn on the patient’s chest and monitors heart rate, respiratory rate and temperature continuously, and alerts the nurse when there is deviation from pre-set physiological norms. Feasibility was assessed by evaluating recruitment rate, adherence to protocol and randomisation and the amount of missing data. Clinical outcomes included time to antibiotics in cases of sepsis, length of hospital stay, number of critical care admissions and rate of hospital readmission within 30 days of discharge.ResultsOne hundred and thirty-six patients were randomised between October 2018 and April 2019: 67 to the control group and 69 to the intervention group. Recruitment was completed prior to the 12 month target with a high rate of eligibility and consent. Missing data was limited only to questionnaire responses; no participants were lost to follow-up and only one participant was withdrawn due to loss of capacity. The number of patients classed as ‘drop-out’ due to design (8.1%) were less than anticipated, and there were no participants who crossed over into the alternative trial allocation group. Seventeen participants in the intervention group (28%) did not adhere to the monitoring protocol. No formal comparisons between arms was undertaken; however, participants had fewer unplanned critical care admissions (1 versus 5) and had a shorter average length of hospital stay (11.6 days (95% confidence interval 9.5–13.7 days) versus 16.2 days (95% confidence interval 11.3–21.2 days)) in the continuous vital signs monitoring group. The time taken to receive antibiotics in cases of sepsis was similar in both arms. A cost-utility analysis indicated that the remote monitoring system was cost-saving when compared to standard NEWS monitoring alone.ConclusionsIt is feasible to perform a large-scale randomised controlled trial of continuous remote monitoring after major surgery. Progression to a definitive multicentre randomised controlled trial would be appropriate, taking consideration of factors, such as patient adherence, that might mask the potential benefit of additional monitoring.Trial registrationISRCTN registry with study ID ISRCTN16601772. Registered 30 August 2017.
Highlights
Despite medical advances, major surgery remains high risk with up to 44% of patients experiencing postoperative complications
A costutility analysis indicated that the remote monitoring system was cost-saving when compared to standard National Early Warning Score (NEWS) monitoring alone
Progression to a definitive multicentre randomised controlled trial would be appropriate, taking consideration of factors, such as patient adherence, that might mask the potential benefit of additional monitoring
Summary
Major surgery remains high risk with up to 44% of patients experiencing postoperative complications. Recognition of postoperative complications is crucial in reducing morbidity and preventing long-term disability. Patients having major surgery are at high risk of complications, some of which can be life-threatening. Rates of complications can be as high as 33–44% in patients undergoing surgery for gastro-intestinal cancers [1]. Recognition of postoperative complications is crucial in reducing morbidity and preventing long-term disability; for patients with septic shock, there is an 8% increase in mortality for every hour of delay in antibiotic administration [2]. The recording of patients’ vital signs is a key aspect of monitoring for complications. In the postoperative period, NEWS will be calculated half hourly for the first few hours; if the patient remains stable, the frequency will decrease to 2-hourly and 4-hourly, until the patient is ready for discharge when the NEWS may be recorded only twice a day
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