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. 2023 Sep;33(9):2725-2733.
doi: 10.1007/s11695-023-06637-9. Epub 2023 Jul 7.

Lessons Learned from Telemonitoring in an Outpatient Bariatric Surgery Pathway-Secondary Outcomes of a Patient Preference Clinical Trial

Elisabeth S van Ede  1   2 , Jai Scheerhoorn  3 , Friso M J F Schonck  3 , Jonna A van der Stam  4 , Marc P Buise  5 , Simon W Nienhuijs  3 , R Arthur Bouwman  6   7
Affiliations

Lessons Learned from Telemonitoring in an Outpatient Bariatric Surgery Pathway-Secondary Outcomes of a Patient Preference Clinical Trial

Elisabeth S van Ede et al. Obes Surg. 2023 Sep.

Abstract

Background: Remote monitoring is increasingly used to support postoperative care. This study aimed to describe the lessons learned from the use of telemonitoring in an outpatient bariatric surgery pathway.

Materials and methods: Patients were assigned based on their preference to an intervention cohort of same-day discharge after bariatric surgery. In total, 102 patients were monitored continuously for 7 days using a wearable monitoring device with a Continuous and Remote Early Warning Score-based notification protocol (CREWS). Outcome measures included missing data, course of postoperative heart and respiration rate, false positive notification and specificity analysis, and vital sign assessment during teleconsultation.

Results: In 14.7% of the patients, data for heart rate was missing for > 8 h. A day-night-rhythm of heart rate and respiration rate reappeared on average on postoperative day 2 with heart rate amplitude increasing after day 3. CREWS notification had a specificity of 98%. Of the 17 notifications, 70% was false positive. Half of them occurred between day 4 and 7 and were accompanied with surrounding reassuring values. Comparable postoperative complaints were encountered between patients with normal and deviated data.

Conclusion: Telemonitoring after outpatient bariatric surgery is feasible. It supports clinical decisions, however does not replace nurse or physician care. Although infrequent, the false notification rate was high. We suggested additional contact may not be necessary when notifications occur after restoration of circadian rhythm or when surrounding reassuring vital signs are present. CREWS supports ruling out serious complications, what may reduce in-hospital re-evaluations. Following these lessons learned, increased patients' comfort and decreased clinical workload could be expected.

Trial registration: ClinicalTrials.gov. Identifier: NCT04754893.

Keywords: Clinical practice; Continuous and remote monitoring; Outpatient bariatric surgery; Telemonitoring.

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Conflict of interest statement

The authors E.S. van Ede, J. Scheerhoorn, F.M.J.F. Schonck, J.A van der Stam, and M.P. Buise have no potential conflicts of interest to declare. S.W. Nienhuijs receives an educational grant from Medtronic to the obesity center and R.A. Bouwman acts as a clinical consultant for Philips Research.

Figures

Fig. 1
Fig. 1
Amount of missing data for heart rate. Missing data heart rate (A) and respiration rate (B), activity level (C), missing data gaps > 2 h (D) and missing data gaps > 8 h (E). X-axis: days postoperative, Y-axis: A and B percentage and C activity level, and D and E activity level
Fig. 2
Fig. 2
Postoperative course heart rate and respiration rate. X-axis: days postoperative, Y-axis: heart rate in beats per minute. Red line: median heart rate (upper) and respiration rate (lower); the cloud around it represents the IQR
Fig. 3
Fig. 3
Heart rate trend in patients with false positive notifications. Four different patients with false positive notifications in who contact seemed necessary. HR = heart rate, X-axis = days postoperative, Y-axis = HR in bpm, solid line = median HR, dots = outliers, diamond shape = notification
Fig. 4
Fig. 4
Heart rate trend in patients with false positive notifications with reassuring values. Five different patients with false positive notifications in who contact seemed not necessary. HR = heart rate, X-axis = days postoperative, Y-axis = HR in bpm, solid line = median HR, dots = outliers, diamond shape = notification
See this image and copyright information in PMC

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