The association between vital signs abnormalities during postanaesthesia care unit stay and deterioration in the general ward following major abdominal cancer surgery assessed by continuous wireless monitoring.

Objective: Vital signs abnormalities in the post-anaesthesia care unit (PACU) may identify patients at risk of severe postoperative complications in the general ward, but are sparsely investigated by continuous monitoring. We aimed to assess if the severity of vital signs abnormalities in the PACU was correlated to the duration of severe vital signs abnormalities and serious adverse events (SAEs) in the general ward. Design: Prospective cohort study. Primary exposure was PACU vital signs abnormalities assessed by a standardised PACU recovery score. Participants: Adult patients, aged ≥ 60 years, who underwent major abdominal cancer surgery. Main outcome measures: The duration of severe vital signs abnormalities were assessed by continuous wireless vital signs monitoring and, secondly, by any SAE within the first 96 hours in the general ward. Results: One-hundred patients were included, and 92 patients with a median of 91 hours (interquartile range, 71-95 hours) of vital signs recording were analysed. The maximum vital signs abnormalities in the PACU were not significantly correlated to overall vital signs abnormalities in the general ward (R = 0.13; P = 0.22). Severe circulatory abnormalities in the overall PACU stay and at discharge were significantly correlated to the duration of circulatory vital signs abnormalities on the ward ( R = 0.32 [ P = 0.00021] and R = 0.26 [ P = 0.014], respectively). Seventeen patients (18%) experienced SAEs, without significant association to the PACU stay (area under the receiver operating characteristic [AUROC], 0.59; 95% CI, 0.46-0.73). Conclusion: Vital signs abnormalities in the PACU did not show a tendency towards predicting overall severe vital signs abnormalities or SAEs during the first days in the general ward. Circulatory abnormalities in the PACU showed a tendency towards predicting circulatory complications in the ward.
Competing Interests: The WARD-project receives core support from the Novo Nordic Foundation; the Danish Cancer Society (R150-A9865-16-S48); Copenhagen Center for Health Technology (CACHET); Steno Diabetes Centers, Denmark; Radiometer; AP Møller Foundation, as well as cofunding from Bispebjerg and Frederiksberg Hospital, Rigshospitalet and the Technical University of Denmark. No industry partner had any role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. Christian Meyhoff, Eske Aasvang and Helge Sørensen have founded a start-up company, WARD247 ApS, with the aim of pursuing the regulatory and commercial activities of the WARD-project (Wireless Assessment of Respiratory and Circulatory Distress, a project developing a clinical support system for continuous wireless monitoring of vital signs). WARD247 ApS has obtained license agreement for any WARD-project software and patents. One patent has been filed: "Wireless Assessment of Respiratory and circulatory Distress (WARD), EP 21184712.4 and EP 21205557.8". In addition, Christian Meyhoff reports direct and indirect departmental research funding from Boehringer Ingelheim and Merck, Sharp and Dohme, as well as lecture fees from Radiometer. None of the above entities have influence on the study design, conduct, analysis or reporting.
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