Project R-15493

Remote clinical monitoring at home after major surgery: A comprehensive study on patient perceptions, implementation, clinical impact, and cost-effectiveness (Research)

Advancements in minimally invasive surgery (MIS) and enhanced recovery after surgery (ERAS) protocols have made early hospital discharge feasible for patients undergoing major surgical procedures, including pancreatic, liver, lung, and gastric bypass surgeries. However, safely reducing hospital length of stay (LOS) remains a significant challenge due to the persistent risk of early, unrecognized postoperative complications. Besides this, hospitals are under increasing pressure due to increasing surgical volumes, high bed occupancy rates, and persistent and worsening workforce shortages. These challenges underscore the urgent need for innovative, scalable care pathways that support both clinical safety and health system efficiency. This project proposes the development and evaluation of a sustainable, hybrid postoperative care model that integrates remote patient monitoring (RPM) and digital recovery support, tailored to the patient's needs, into routine surgical practice. The primary objective is to determine whether wearable-based remote monitoring can facilitate safe, expedited discharge while reducing postoperative complications and unplanned readmissions and improving patient-reported outcomes and experiences (PROMs and PREMs). We hypothesize that such a hybrid pathway will not only improve clinical safety but also reduce hospital burden. A multicenter, randomized controlled trial (RCT) will be conducted across two Belgian hospitals, enrolling 300 patients undergoing pancreatic, liver, lung, or gastric bypass surgery. This trial builds upon a phased research approach. An initial survey study assessed patient perspectives on wearable technologies, informing the development of patient-centered digital tools and ensuring higher acceptability and engagement. Pilot studies in pancreatic, liver, lung, and gastric bypass patients evaluated the feasibility and adherence to remote monitoring. These preliminary studies informed the design of the hybrid care pathways used in the RCT. Participants in the intervention group will be discharged as early as medically appropriate and remotely monitored at home for 10 days using wearable devices measuring vital signs (heart rate, respiratory rate, oxygen saturation, and temperature). A centralized telemonitoring hub will manage escalation protocols triggered by deviations from predefined thresholds. In parallel, patients will receive tailored recovery guidance via a mobile application to promote early mobilization, symptom management, and self-engagement in recovery. The control group will receive standard ERAS-based postoperative care. The primary outcome is hospital length of stay. Secondary outcomes include postoperative complication and readmission rates, quality of life, recovery experience, digital health readiness, patient satisfaction, and a comprehensive cost-effectiveness analysis from hospital, patient, and societal perspectives. Implementation outcomes will also be assessed for real-world feasibility and scalability, including recruitment rates, protocol adherence, and healthcare provider workload. This study aims to provide robust evidence on the clinical, economic, and operational value of RPM-enabled, patient-centered postoperative care. If successful, the findings may support the widespread adoption of digital monitoring pathways as a safe and sustainable strategy to improve recovery and optimize healthcare resource utilization in the context of major surgery.

01 October 2024 - 31 December 2025