(E-180) Assessing the Efficacy and Utility of Wearables for Perioperative Patient Monitoring

Introduction:: With improved perioperative care, hospital stays after major operations have decreased in duration. The average hospital length of stay (LOS) after colectomy surgery has declined while readmissions rates for this procedure have increased. As a result, for patients undergoing such surgeries, there remains a persistently high rate of costly readmissions due to infection, prolonged ileus, hemorrhage, thromboembolic events, anastomotic leak, and dehydration. As implementation of Enhanced Recovery After Surgery (ERAS) protocols to reduce post-operative LOS continues to increase, patient complications which once were noticed in the hospital are now presenting when the patient is home. Increasingly post-operative care is being transitioned from hospital to home, which creates a void in capturing physiologic data for complications after discharge. Complications and readmissions can be the result of minor, correctable physiologic derangements, (e.g., acute kidney injury which could be prevented with early management of dehydration from an ileostomy). Therefore, there is a clear need to determine whether an unobtrusive, inexpensive, and accurate outpatient monitoring strategy can be developed to alert providers of evolving complications and allow for early clinical rescue.

Dramatic improvements in mobile health technologies provide an unprecedented opportunity to address these gaps to better define postoperative complications and revolutionize their detection. The central hypothesis is that mobile health technologies can be used to predict and detect post-operative complications and to passively screen for events on an outpatient basis following hospital discharge. With support from Duke University’s Office for Research and Innovation, we have launched a feasibility study to test this hypothesis.


Materials and Methods:: In our study, we seek to monitor up to 50 participants with the Oura Ring and Garmin smartwatch and assess whether they can provide continuous monitoring of surgery patients in the perioperative setting. Specifically, participants are asked to wear both devices up to two weeks prior to a planned surgical procedure and up to six weeks post-surgery. Participants also receive daily online surveys throughout the study to assess severity and location of pain (Figure 1). Participant data is then processed to determine 1) the adherence to wearing the wearable devices and 2) the ability of the wearable device data and derived digital biomarkers to predict post-operative morbidity and mortality via statistical and machine learning methods.


Results, Conclusions, and Discussions:: To date we have enrolled 13 participants, 10 of which have undergone surgery. By Oct 2023, we expect to have the entire cohort of 50 participants enrolled. Of the 10 postoperative participants, one experienced outpatient complications. This participant's wearable data revealed deviations that could potentially be linked to the exhibited complications (Figure 2). Throughout the study, patient adherence to wearing the wearable devices has been high. In particular, the mean patient adherence to the Oura Ring has been over 95%. As of April 2023, our study protocol has been amended to also include transplantation patients. We believe this will increase the incidence of complications that occur during the postoperative setting and provide a more robust data set for future predictive model development.



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