Post-discharge Telemonitoring of Physical Activity, Vital Signs, and Patient-Reported Symptoms in Older Patients Undergoing Cancer Surgery.
Post-discharge Telemonitoring of Physical Activity, Vital Signs, and Patient-Reported Symptoms in Older Patients Undergoing Cancer Surgery.
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DOI：
10.1245/s10434-021-09707-3
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发表时间：
2021-10
影响因子：
3.7
通讯作者：
van Leeuwen BL
中科院分区：
文献类型：
--
作者：
Jonker LT;Lahr MMH;Oonk MHM;de Bock GH;van Leeuwen BL
术后家庭监测可能早期发现并发症，但在老年肿瘤手术中的证据很少。因此，我们评估了接受癌症手术的老年患者出院后体力活动、生命体征和患者报告的症状是否与出院后并发症和再入院有关。在这项观察性队列研究中，我们使用基于平板电脑的应用程序和连接设备对接受癌症手术的老年患者（≥ 65岁）进行了出院后2周的监测。结果指标为出院后并发症和再入院;随着时间的推移，体力活动和患者报告的症状;以及体力活动的阈值违反（步数<1000步/天），生命体征（体温<36 ° C或> 38 ° C;血压<100/60 mmHg或> 150/100 mmHg;心率100 bpm;出院时体重的-5%或+5%）;<50 bpm or >和患者报告的症状（疼痛评分大于前一天;存在呼吸困难、呕吐、头晕、发热）。在58例患者（平均年龄72岁）中，24例发生出院后并发症，13例再次入院。在40例患者的5379次测量中，测量参数显示392次阈值违规（7.3%），主要是由于身体活动不足。再入院患者在出院时和出院后第9天的体力活动较低，并且更经常违反体力活动阈值。与没有这些不良事件的患者相比，有出院后并发症的患者的中位疼痛评分更高。在有和没有出院后并发症和再入院的患者之间，观察到其他参数的阈值违反没有差异。我们的研究结果显示了远程监护老年患者癌症手术后的潜力，但证实检测出院后并发症是复杂的和多因素的。在线版本包含补充材料，可通过10.1245/s10434 - 021 - 09707 - 3获得。
Postoperative home monitoring could potentially detect complications early, but evidence in oncogeriatric surgery is scarce. Therefore, we evaluated whether post-discharge physical activity, vital signs, and patient-reported symptoms are related to post-discharge complications and hospital readmissions in older patients undergoing cancer surgery. In this observational cohort study, we monitored older patients (≥65 years of age) undergoing cancer surgery, for 2 weeks post-discharge using tablet-based applications and connected devices. Outcome measures were post-discharge complications and readmissions; physical activity and patient-reported symptoms over time; and threshold violations for physical activity (step count <1000 steps/day), vital signs (temperature <36°C or >38°C; blood pressure <100/60 mmHg or >150/100 mmHg; heart rate <50 bpm or >100 bpm; weight −5% or +5% of weight at discharge); and patient-reported symptoms (pain score greater than the previous day; presence of dyspnea, vomiting, dizziness, fever). Of 58 patients (mean age 72 years), 24 developed a post-discharge complication and 13 were readmitted. Measured parameters indicated 392 threshold violations out of 5379 measurements (7.3%) in 40 patients, mostly because of physical inactivity. Patients with readmissions had lower physical activity at discharge and at day 9 after discharge and violated a physical activity threshold more often. Patients with post-discharge complications had a higher median pain score compared with patients without these adverse events. No differences in threshold violations of other parameters were observed between patients with and without post-discharge complications and readmissions. Our results show the potential of telemonitoring older patients after cancer surgery but confirm that detecting post-discharge complications is complex and multifactorial. The online version contains supplementary material available at 10.1245/s10434-021-09707-3.
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