Postoperative Home Monitoring After Joint Replacement: Feasibility Study

Abstract

© Homer Yang, Geoff Dervin, Susan Madden, Paul E Beaulé, Sylvain Gagné, Mary L Crossan, Ashraf Fayad, Kathryn Wheeler, Melody Afagh, Tinghua Zhang, Monica Taljaard. Originally published in JMIR Perioperative Medicine (http://periop.jmir.org),05.09.2018. This is an open-access article distributed under the terms of the Creative Commons Attribution License. Background: We conducted a prospective observational study of patients undergoing elective primary hip or knee replacements to examine the feasibility of a postoperative home monitoring system as transitional care to support patients following their surgery in real time. Objective: The primary outcome was the mean percentage of successful wireless transmissions from home of blood pressure levels, heart rate, oxygen saturation levels, and pain scores until postoperative day 4 with a feasibility target of ≥90%. Methods: Patients with an expected length of stay ≤1 day, age 18-80 years, Revised Cardiac Risk Index ≤ class 2, and caretakers willing to assist at home were eligible. Patient satisfaction, as a secondary outcome, was also evaluated. Wireless monitoring equipment (remote patient monitoring, Telus Canada) was obtained and a multidisciplinary care team was formed. Results: We conducted the study after obtaining Research Ethics Board approval; 54 patients completed the study: 21 males, 33 females. In total, we evaluated 9 hips, 4 hip resurfacing, 26 total knees, and 15 hemi-knees. The mean transmission rate was 96.4% (SD 5.9%; 95% CI 94.8-98.0). The median response to “I would recommend the Remote Monitoring System program to future patients” was 4.5 (interquartile range 4-5), with 1 being “strongly disagree” and 5 “strongly agree.” At 30 days postop, there was no mortality or readmission. Conclusions: This is an evolving new paradigm for postoperative care and the first feasibility study on monitoring biometrics after primary hip or knee replacement. Postoperative home monitoring combines current technology with real-time support by a multidisciplinary transitional care team after discharge, facilitating postsurgical care with successful wireless transmission of vitals. The postoperative home monitoring implementation is, therefore, generalizable to other surgical discharges from hospitals.