Improving post-operative care during COVID-19 pandemic: Wearable sensors identify clinical deterioration in patients monitored at home following radical cystectomy

Introduction: Radical cystectomy (RC) has 30-day and 90-day re-admission rates of 15% and 20% respectively. Majority of complications such as infective and bowel-related are frequently associated with changes in vital signs. The primary aim was to compliance and feasibility of using remote monitoring in patients discharged following RC. Secondary endpoints included monitoring for adverse events. Materials & Methods: Patients consented to a 30-day monitoring period commencing on discharge (Day 1). A wearable sensor was worn continuously, intermittent monitoring and a PROM (quality-of-recovery-15 questionnaire (QoR15) was also completed using a bespoke app. Data was collected in real-time to a secure server (Ethera.health) was assessed in the DREAMPath study (ISRCTN62293620). Readmission and complications (CD grades I-V) were recorded. Results: Compliance with the wearable device and interaction with the app and PROM was high. In 16% of cases a significant adverse event necessitating readmission was recorded. On average 5,687 data points were collected for each case over 30 days. A measure of physiological performance status derived from the wearable device alone was applied across the study cohort and identified clinical deterioration in 75% of cases at least 48 hrs before readmission. A combination of performance measurement and the QoR15 identified clinical deterioration in all cases prior to admission. Conclusions: Remote monitoring is feasible, and patients can engage with it with minimal effort. In the COVID era, this is invaluable as this data can be used to triage patients remotely and treat complications early.