Postoperative ward monitoring – Why and what now?

Khanna, Ashish K.; Ahuja, Sanchit; Weller, Robert S.; Harwood, Timothy N.

doi:10.1016/j.bpa.2019.06.005

Cited by 22 publications

(16 citation statements)

References 92 publications

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“…The added value of continuous remote monitoring on morbidity and mortality after general or bariatric surgery has not been established yet. Large datasets and future studies are needed to elaborate on this aspect, but also to improve monitoring and alarming techniques [ 34 – 37 ]. Nevertheless, we envision that the results and experiences gained from the outpatient monitoring pathway in the present study, can serve as a blueprint for rolling out telemonitoring for other perioperative care pathways.…”

Section: Discussionmentioning

confidence: 99%

Telemonitoring for perioperative care of outpatient bariatric surgery: Preference-based randomized clinical trial

et al. 2023

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Importance Implementation of bariatric surgery on an outpatient basis is hampered by concerns about timely detection of postoperative complications. Telemonitoring could enhance detection and support transition to an outpatient recovery pathway. Objective This study aimed to evaluate non-inferiority and feasibility of an outpatient recovery pathway after bariatric surgery, supported by remote monitoring compared to standard care. Design Preference-based non-inferiority randomized trial. Setting Center for obesity and metabolic surgery, Catharina hospital Eindhoven, the Netherlands. Participants Adult patients scheduled for primary gastric bypass or sleeve gastrectomy. Interventions Same-day discharge with one week ongoing Remote Monitoring (RM) of vital parameters or Standard Care (SC) with discharge on postoperative day one. Main outcomes Primary outcome was a thirty-day composite Textbook Outcome score encompassing mortality, mild and severe complications, readmission and prolonged length-of-stay. Non-inferiority of same-day discharge and remote monitoring was accepted below the selected margin of 7% upper limit of confidence interval. Secondary outcomes included admission duration, post-discharge opioid use and patients’ satisfaction. Results Textbook Outcome was achieved in 94% (n = 102) in RM versus 98% (n = 100) in SC (RR 2.9; 95% CI, 0.60–14.23, p = 0.22). The non-inferiority margin was exceeded which is a statistically inconclusive result. Both Textbook Outcome measures were above Dutch average (5% RM and 9% SC). Same-day discharge reduced hospitalization days by 61% (p<0.001) and by 58% with re-admission days included (p<0.001). Post-discharge opioid use and satisfaction scores were equal (p = 0.82 and p = 0.86). Conclusion In conclusion, outpatient bariatric surgery supported with telemonitoring is clinically comparable to standard overnight bariatrics in terms of textbook-outcome. Both approaches reached primary endpoint results above Dutch average. However, statistically the outpatient surgery protocol was neither inferior, nor non-inferior to the standard pathway. Additionally, offering same-day discharge reduces the total hospitalization days while maintaining patient satisfaction and safety.

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Section: Discussionmentioning

confidence: 99%

Telemonitoring for perioperative care of outpatient bariatric surgery: Preference-based randomized clinical trial

et al. 2023

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“…Flaps are common in plastic surgery and are used to reconstruct large tissue defects in situations such as trauma or cancer . However, most tissue oximeters used to monitor postoperative flap ischemia are complex and cumbersome wired devices that hinder direct observation of the postoperative flap . In view of this, Evans and co-workers further mixed the internal standard molecular fluorescein and Pd porphyrin in a liquid bandage.…”

Section: Inflammation In the Bodymentioning

confidence: 99%

“…63 However, most tissue oximeters used to monitor postoperative flap ischemia are complex and cumbersome wired devices that hinder direct observation of the post-operative flap. 64 In view of this, Evans and co-workers further mixed the internal standard molecular fluorescein and Pd porphyrin in a liquid bandage. The bandage was then coated on the flap of the patient after flap surgery and isolated from air by a transparent dressing.…”

Section: Skin Inflammationmentioning

confidence: 99%

Fluorescence Imaging of Inflammation with Optical Probes

Zhou

Chen

et al. 2023

Chemical & Biomedical Imaging

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Inflammation plays an important role in the occurrence and development of disease; dysregulation of inflammatory progression often leads to disease such as tissue sclerosis, cancers, stroke, etc. Optical imaging technology, due to its higher sensitivity and resolution, can provide finer images for the observation of inflammation. Many optical probes have been developed as contrast agents for optical imaging techniques in different diseases. In this review, we summarize the recent advances of optical probe and imaging methods for imaging inflammation in different organs, such as brain, liver, lung, kidney, intestine, etc. Finally, we discuss the opportunities and challenges of optical probes used in the clinic for inflammation monitoring and prospect their future development in disease detection.

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“…The exact added value of these systems to patients’ outcomes remains uncertain [ 6 , 7 ], presumably due to poor protocol compliance, inaccurate recordings and the periodic nature of the vital sign measurements [ 8 – 11 ], which can result in clinical deterioration to progress unnoticed [ 12 – 14 ]. Continuous vital sign monitoring (CM) on general wards has been advocated to enable early detection of clinical deterioration and to improve patient outcome [ 15 – 18 ]. In 2010 we introduced a Modified Early Warning Score (MEWS) in our hospital which gradually evolved based on existing EWSs and local expert opinion [ 19 – 21 ].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Continuous Versus Periodic Vital Sign Monitoring on Disease Severity of Patients with an Unplanned ICU Transfer

et al. 2023

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Continuous vital sign monitoring (CM) may detect ward patient’s deterioration earlier than periodic monitoring. This could result in timely ICU transfers or in a transfer delay due to misperceived higher level of care on the ward. The primary objective of this study was to compare patient’s disease severity upon unplanned ICU transfer, before and after CM implementation. We included a one-year period before and after CM implementation between August 1, 2017 – July 31, 2019. Before implementation, surgical and internal medicine patients’ vital signs were periodically monitored, compared to continuous monitoring with wireless linkage to hospital systems after implementation. In both periods the same early warning score (EWS) protocol was in place. Primary outcome was disease severity scores upon ICU transfer. Secondary outcomes were ICU and hospital length of stay, incidence of mechanical ventilation and ICU mortality. In the two one-year periods 93 and 59 unplanned ICU transfer episodes were included, respectively. Median SOFA (3 (2–6) vs 4 (2–7), p = .574), APACHE II (17 (14–20) vs 16 (14–21), p = .824) and APACHE IV (59 (46–67) vs 50 (36–65), p = .187) were comparable between both periods, as were the median ICU LOS (3.0 (1.7–5.8) vs 3.1 (1.6–6.1), p.962), hospital LOS (23.6 (11.5–38.0) vs 19 (13.9–39.2), p = .880), incidence of mechanical ventilation (28 (47%) vs 22 (54%), p.490), and ICU mortality (11 (13%) vs 10 (19%), p.420). This study shows no difference in disease severity upon unplanned ICU transfer after CM implementation for patients who have deteriorated on the ward.

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Postoperative ward monitoring – Why and what now?

Cited by 22 publications

References 92 publications

Telemonitoring for perioperative care of outpatient bariatric surgery: Preference-based randomized clinical trial

Telemonitoring for perioperative care of outpatient bariatric surgery: Preference-based randomized clinical trial

Fluorescence Imaging of Inflammation with Optical Probes

The Effect of Continuous Versus Periodic Vital Sign Monitoring on Disease Severity of Patients with an Unplanned ICU Transfer

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