Telemonitoring for perioperative care of outpatient bariatric surgery: Preference-based randomized clinical trial

Implementation of bariatric surgery on an outpatient basis is hampered by concerns about timely detection of postoperative complications. Telemonitoring could enhance detection and support transition to an outpatient recovery pathway. This study aimed to evaluate non-inferiority and feasibility of a...

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Bibliographic Details
Published in:PloS one 2023-02, Vol.18 (2), p.e0281992-e0281992
Main Authors: van Ede, E S, Scheerhoorn, J, Buise, M P, Bouwman, R A, Nienhuijs, S W
Format: Article
Language:English
Subjects:
Adult
Aftercare
Analgesics, Opioid
Bariatric Surgery - methods
Clinical trials
Complications
Design standards
Evaluation
Gastrectomy
Gastric bypass
Gastrointestinal surgery
Health risks
Heart rate
Hospital costs
Humans
Length of Stay
Medical care
Medicine and Health Sciences
Mortality
Obesity
Obesity, Morbid - surgery
Opioids
Outpatients
Patient Discharge
Patient satisfaction
Patients
Perioperative care
Perioperative Care - adverse effects
Postoperative
Postoperative Complications - etiology
Quality management
Remote monitoring
Respiration
Retrospective Studies
Social Sciences
Surgery
Telemedicine
Treatment Outcome
Vital signs
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Summary:Implementation of bariatric surgery on an outpatient basis is hampered by concerns about timely detection of postoperative complications. Telemonitoring could enhance detection and support transition to an outpatient recovery pathway. This study aimed to evaluate non-inferiority and feasibility of an outpatient recovery pathway after bariatric surgery, supported by remote monitoring compared to standard care. Preference-based non-inferiority randomized trial. Center for obesity and metabolic surgery, Catharina hospital Eindhoven, the Netherlands. Adult patients scheduled for primary gastric bypass or sleeve gastrectomy. Same-day discharge with one week ongoing Remote Monitoring (RM) of vital parameters or Standard Care (SC) with discharge on postoperative day one. Primary outcome was a thirty-day composite Textbook Outcome score encompassing mortality, mild and severe complications, readmission and prolonged length-of-stay. Non-inferiority of same-day discharge and remote monitoring was accepted below the selected margin of 7% upper limit of confidence interval. Secondary outcomes included admission duration, post-discharge opioid use and patients' satisfaction. Textbook Outcome was achieved in 94% (n = 102) in RM versus 98% (n = 100) in SC (RR 2.9; 95% CI, 0.60-14.23, p = 0.22). The non-inferiority margin was exceeded which is a statistically inconclusive result. Both Textbook Outcome measures were above Dutch average (5% RM and 9% SC). Same-day discharge reduced hospitalization days by 61% (p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0281992