Monitoring Patients More Effectively to Minimize Complications after Surgery
By Carla Todaro, MD, from the IARS, AUA and SOCCA 2019 Annual Meetings*
Complications occur. We can’t eliminate them, but we can minimize them. This was one of the major takeaways from the panel, Anesthesiologists as Monitors of Physiology: Remote Monitoring of Postoperative and High-Risk Patients, held on Monday, May 20. The panel sought to identify ways in which anesthesiologists can better monitor patients and avoid complications where possible.
The panel was moderated by Jeanine P. Wiener-Kronish, MD, Massachusetts General Hospital, and presented by Kyan C. Safavi, MD, MBA, Massachusetts General Hospital and Harvard Medical School, from Massachusetts General Hospital, Wolfgang Buhre, MD, PhD, University Clinic Maastricht, Kenneth T. Shelton, MD, Massachusetts General Hospital, and Stephen A. Esper, MD, University of Pittsburgh Medical Center.
Dr. Wiener-Kronish asked the presenters to consider the question, “How do we avoid the failure to rescue?”
Dr. Esper was the first to answer the question. He highlighted the necessity of prehabilitation and preoperative monitoring as well as the evaluation of nutrition state, mental health, anemia and frailty as part of the preoperative assessment.
The preoperative period (prehabilitation) can represent the right time to implement an intervention.
TRACE (Routine posTsuRgical Anesthesia visit to improve patient outComE): a prospective, multicenter, interventional study presented by Dr. Buhre, underlined that regular visits, performed by trained health professionals, decrease the incidence of complications and mortality due to earlier detection and adequate treatment of complications.
Another study International Surgical Outcomes Study (ISOS), which is similar to the European Surgical Outcomes Study (EuSOS), collected data on every eligible patient who has surgery during the study week and followed them until they left the hospital to collect further data on complications after surgery.
However, remote monitoring generates questions in terms of broadband security and legal standards. Dr. Safavi presented a study from Massachusetts General Hospital where remote patient surveillance systems were developed to increase the timeliness and quality of patient care. Patches, wearables, and biosensors allow for continuous physiological data collection in the postoperative time period.
These data potentially enable the early recognition of patterns of clinical deterioration, improving predictions.
Dr. Shelton presented aspects of “remote monitoring” in particular the experience of the heart center and how this has implemented a better monitoring of medical complex patients.
*Coverage from the panel, Anesthesiologists as Monitors of Physiology: Remote Monitoring of Postoperative and High-Risk Patients during the IARS 2019 Annual Meeting