Towards clinical application of perioperative telemonitoring

Patients undergoing major abdominal surgery are at high-risk of postoperative complications. Telemonitoring is the remote monitoring of patients, for example by monitoring vital signs such as heart rate with wearable sensors for early detection of postoperative deterioration. However, the evidence for the effectiveness of perioperative telemonitoring on postoperative outcomes or healthcare costs is still scarce. This could be due to limited quality of used technology. Besides, its use should be feasible for patients, and it is unknown when and how often patients should be monitored before and after surgery. This thesis showed that quality of three available wearable sensors varied for monitoring vital signs (heart rate, respiratory rate, blood oxygen saturation and temperature) during daily activities in volunteers. Moreover, data availability and accuracy of these wearable sensors decreased during the more active tasks such as walking. In patients at the surgical ward, only heart rate measured by a wearable sensor had moderate validity compared to nurse measurements. Feasibility assessment showed high patient satisfaction and compliance with wearing a sensor and answering daily questions in an app before and after surgery. Meanwhile, surgery-related mental burden and recurrent technical issues were main barriers for patient participation. Furthermore, this thesis indicated a measurement period of at least three consecutive days is sufficient to get reliable values of heart rate and daily steps before surgery at home measured by a wearable sensor. In addition, this thesis provides useful recommendations towards clinical application of perioperative telemonitoring