Ward Monitoring

Close monitoring of post-surgical patients for early warning of deterioration
  • 30 days post-operative mortality is the 3rd leading cause of death in the US
  • Mortality is largely related to cardiovascular complications, mainly myocardial infarction (MI)
  • Hypotension is a major contributor to developing MI, however hypotension events are often missed in the wards since BP is measured only once every 4-6 hours
  • Sensifree’s continuous and non-invasive BP monitoring device allows timely identification of hypotension conditions and early intervention

Counterintuitively, the risk associated with the post-operative period is extremely high in comparison to all other stages of the surgical procedure. When patients having a major surgery safely reach the post-anesthesia care unit, it is assumed that they have survived the most dangerous part of the perioperative experience. However, significant risk is presented in the post-operative period. Mortality rate in the 30 days after surgery is orders of magnitude higher than intraoperative mortality1,2. In fact, if the month after surgery was considered a distinct disease, it would be the third leading cause of death in the United States3. The numbers are rather grave: about 2% of U.S. surgical inpatients, age 45 years or more, die within 30 days of the surgical procedure4. Most postoperative mortality occurs during the initial hospitalization period, while patients are under full medical care.

 

Thirty-day all-cause mortality is largely related to cardiovascular complications, particularly myocardial infarctions (MI)5,6. About 12% of surgical inpatients more than 45 years of age have an infarction, usually within the initial 3 postoperative days7. Patients who survived MI will stay longer in hospital, suffer long term adverse effects and reduced life expectancy.

Life-threatening complications are usually preceded by abnormalities in vital signs that occur minutes to hours earlier8. Vital signs are usually obtained in regular wards at 4-6-hour intervals. In a clinician and patient-blinded prospective observational cohort, it was recently shown that ward hypotension is common, profound, and prolonged – and nearly always missed9. Identification of even subtle changes in basic vital signs will allow clinicians to detect deterioration well before serious adverse events occur. Consequent clinical interventions will in turn prevent complications, or at least moderate their severity.

 

There is no technology today that allows frequent monitoring of blood pressure in a manner that is well-tolerated by patients and is low cost.

 

Sensifree’s affordable, patient-friendly, and easy to use method for non-invasive continuous BP (cNIBP) monitoring, offers a great value in the treatment of postoperative patients, as they go through the various stages of their admission and recovery. Our roadmap includes adding additional vital signs to provide the care team a fuller picture of the patient’s condition. These will include SpO2, respiration rate and heart rate.

  1. Li, G., et al: Epidemiology of anesthesia-related mortality in the United States 1999-2005. 2009, Anesthesiology, pp. 759-765.
  2. Pearse, RM., et al.: European Surgical Outcomes Study group for the Trials groups of the European Society of Intensive Care M, the European Society of A: Mortality after surgery in Europe: a 7 day cohort study. 2012, Lancet, pp. 1059-1065.
  3. Bartels, K., et al: Perioperative organ injury. 2013, Anesthesiology, pp. 1474-1489
  4. Devereaux, PJ: The Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators: Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. 2012, JAMA, pp. 2295-2304.
  5. Devereaux, PJ and Sessler, DI: Cardiac complications in patients undergoing major noncardiac surgery. 23, 2015, N Engl J Med, Vol. 373, pp. 2258-2269.
  6. Devereaux PJ et al: Association Between Postoperative Troponin Levels and 30-day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA 2012; 307:2295–304
  7. Devereaux, PJ: The Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators: Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. 2012, JAMA, pp. 2295-2304.
  8. Schein, RM., et al: Clinical antecedents to in-hospital cardiopulmonary arrest. 1990, Chest, Vol. 98, pp. 1388-1392.
  9. Turan, A.; et al.: Incidence, severity, and detection of blood pressure perturbations after abdominal surgery: A prospective blinded observational study. 2019, Anesthesiology, Vol.130, pp. 550-559.