The association between vital signs abnormalities during postanaesthesia care unit stay and deterioration in the general ward following major abdominal cancer surgery assessed by continuous wireless monitoring.

Objective: Vital signs abnormalities in the post-anaesthesia care unit (PACU) may identify patients at risk of severe postoperative complications in the general ward, but are sparsely investigated by continuous monitoring. We aimed to assess if the severity of vital signs abnormalities in the PACU was correlated to the duration of severe vital signs abnormalities and serious adverse events (SAEs) in the general ward. Design: Prospective cohort study. Primary exposure was PACU vital signs abnormalities assessed by a standardised PACU recovery score. Participants: Adult patients, aged ≥ 60 years, who underwent major abdominal cancer surgery. Main outcome measures: The duration of severe vital signs abnormalities were assessed by continuous wireless vital signs monitoring and, secondly, by any SAE within the first 96 hours in the general ward. Results: One-hundred patients were included, and 92 patients with a median of 91 hours (interquartile range, 71-95 hours) of vital signs recording were analysed. The maximum vital signs abnormalities in the PACU were not significantly correlated to overall vital signs abnormalities in the general ward (R = 0.13; P = 0.22). Severe circulatory abnormalities in the overall PACU stay and at discharge were significantly correlated to the duration of circulatory vital signs abnormalities on the ward (R = 0.32 [P = 0.00021] and R = 0.26 [P = 0.014], respectively). Seventeen patients (18%) experienced SAEs, without significant association to the PACU stay (area under the receiver operating characteristic [AUROC], 0.59; 95% CI, 0.46-0.73). Conclusion: Vital signs abnormalities in the PACU did not show a tendency towards predicting overall severe vital signs abnormalities or SAEs during the first days in the general ward. Circulatory abnormalities in the PACU showed a tendency towards predicting circulatory complications in the ward.

Agreement between standard and continuous wireless vital sign measurements after major abdominal surgery: a clinical comparison study.

Objective. Continuous wireless monitoring outside the post-anesthesia or intensive care units may enable early detection of patient deterioration, but good accuracy of measurements is required. We aimed to assess the agreement between vital signs recorded by standard and novel wireless devices in postoperative patients.Approach. In 20 patients admitted to the post-anesthesia care unit, we compared heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), and systolic and diastolic blood pressure (SBP and DBP) as paired data. The primary outcome measure was the agreement between standard wired and wireless monitoring, assessed by mean bias and 95% limits of agreement (LoA). LoA was considered acceptable for HR and PR, if within ±5 beats min-1(bpm), while RR, SpO2, and BP were deemed acceptable if within ±3 breaths min-1(brpm), ±3%-points, and ±10 mmHg, respectively.Main results.The mean bias between standard versus wireless monitoring was -0.85 bpm (LoA -6.2 to 4.5 bpm) for HR, -1.3 mmHg (LoA -19 to 17 mmHg) for standard versus wireless SBP, 2.9 mmHg (LoA -17 to 22) for standard versus wireless DBP, and 1.7% (LoA -1.4 mmHg to 4.8 mmHg) for SpO2, comparing standard versus wireless monitoring. The mean bias of arterial blood gas analysis versus wireless SpO2measurements was 0.02% (LoA -0.02% to 0.06%), while the mean bias of direct observation of RR compared to wireless measurements was 0.0 brpm (LoA -2.6 brpm to 2.6 brpm). 80% of all values compared were within predefined clinical limits.Significance.The agreement between wired and wireless HR, RR, and PR recordings in postoperative patients was acceptable, whereas the agreement for SpO2recordings (standard versus wireless) was borderline. Standard wired and wireless BP measurements may be used interchangeably in the clinical setting.