S. Dong1, R. Barkley1, E. Levine1, M. Howard-McNatt1, P. Shen1, C. J. CLARK1 1Wake Forest University School Of Medicine,General Surgery,Winston-Salem, NC, USA
Introduction: Early mobilization is recognized as a key component of enhanced recovery pathways after surgery. We have developed a highly reliable, real-time location system (RTLS) to monitor patient mobility after surgery. The aim of this study is to evaluate the ability of RTLS to predict postoperative outcomes.
Methods: From Sept 2017 to May 2018, all patients hospitalized in the cancer center surgical ward at an academic medical center were monitored using a network-integrated RTLS comprised of 99 sensors (4,246 total sensors system-wide). Time from surgery to first ambulatory event was measured and evaluated as a predictor of length of stay (LOS) and discharge location.
Results: 358 surgical patients were identified with a median LOS of 4.0 days (IQR 2.3-6.4) and median operative duration of 2.9 hours (IQR 1.9-3.9). Ambulatory monitoring started a median of 3.8 hours (IQR 2.2-5.7) after surgery. 24.0% (n=86) of patients did not have an ambulatory event. Median time to first ambulatory event was 28.6 hours (IQR 21.1-46.8). Delay in first ambulatory event was associated with longer LOS (OR 1.84, 95% CI 1.51-2.25) and need for home health or discharge to facility (OR 1.74, 95% CI 1.32-2.29). After adjusting for patient age, operative duration, and surgical service, first ambulatory event was still associated with LOS and disposition (p<0.001).
Conclusions: Remote monitoring of postoperative ambulation can predict increased health care resource utilization (LOS and non-home discharge) early in a surgical patient’s hospitalization.