Remote Continuous Vital Sign Monitoring of Scoliosis Surgery Patients on General Wards: A Cost-Effectiveness Analysis

Abstract

Background: Scoliosis surgery patients often require continuous postoperative monitoring in intensive care (ICU) or high-dependency units (HDU). We implemented a 24-hour remote continuous monitoring service for high-risk inpatients (HIVE) to allow monitoring in general wards. This study aimed to evaluate the cost-effectiveness of the HIVE service.

Methods: We compared scoliosis surgery patients admitted pre- and postimplementation of the HIVE service and applied multivariable regression to adjust for differences in baseline characteristics. The primary outcome was incremental cost per ICU hour avoided.

Results: We compared 155 patients admitted postimplementation to 133 admitted preimplementation. In the adjusted analysis, the post-HIVE implementation period avoided 27.1 hours in ICU and reduced overall health care costs by AU$2682 (US$2164) per patient, compared with preimplementation. There were no statistically significant differences in hospital length of stay (rate ratio [RR], 1.01; 95% confidence interval [CI], 0.93-1.11; P = .785), emergency readmissions (odds ratio [OR], 0.93; 95% CI, 0.44-1.99; P = .854), or hospital-acquired complications (OR, 0.68; 95% CI, 0.27-1.66; P = .393).

Conclusions: In scoliosis surgery, the implementation of a remote continuous inpatient monitoring service reduced inpatient costs and hours in ICU. In this group of patients, the HIVE service provides economic evidence of the cost-effectiveness of remote monitoring.