Noting that while the trend toward performing TJA as outpatient surgery reduces hospital length of stay (LOS), the practice decreases “available time to monitor for postoperative complications,”1 the authors sought to investigate whether equipping patients with RPM could offer the best of both worlds: outpatient surgery with the ability to track vital signs and more easily stay in touch with patients while they recuperate at home. They enrolled 100 patients who were scheduled to undergo total knee or total hip surgery at SLUHN, divided into two groups: 50 who did not receive RPM after discharge (2021-2022), and 50 who did (2022-2023). Various characteristics (demographics such as age, gender, race, BMI, and marital status; hospital LOS; ASA score; and Charlson Comorbidity Index) were compared between the cohorts and there were no significant differences (p > 0.05), although hospital LOS was slightly shorter in the RPM group (29.4 hours vs. 30.4 hours).
Patients in the RPM cohort were discharged with a Masimo MightySat® pulse oximeter and an Omron blood pressure monitor, provided by Masimo, which connected wirelessly to the Masimo SafetyNet app. For 48 hours after discharge, patients checked their vital signs four times daily. Data recorded by Masimo SafetyNet (including manually entered temperature data) were automatically uploaded to the hospital’s virtual response center for review by hospital clinicians, who reached out to patients as needed to address abnormalities or signs of physiological decline, provide guidance, and, if warranted, recommend returning to the facility for in-person care. Patients in the control group, who did not receive RPM, were discharged with routine TJA postoperative instructions.
The researchers found that in the RPM cohort, 10 patients (20%) recorded abnormal vital signs and 2 patients (4%) visited the ED; no patients were readmitted to the hospital. In the control cohort, 6 patients (12%) visited the ED and all visits resulted in hospital admission – significantly higher rates of ED visitation and hospital readmission (p = 0.03). The causes for the readmissions included two hip dislocations, cellulitis (soft tissue infection), and uncontrolled pain. The authors noted that other than the dislocations, these readmissions “could have been prevented with remote home monitoring.”1 They conservatively estimated a readmission cost of $7,000 per patient.
Although they did not conduct a formal cost analysis of the RPM program, the authors estimated that, after taking into account the potential cost avoidance of fewer hospital readmissions, for every 1,000 TJA surgeries performed, the RPM program “could potentially result in a hospital savings of $800,000.”1
The researchers also surveyed patients in the RPM cohort about their experience and found that most held a favorable view of the program: 79% strongly or somewhat agreed that RPM helped in their care at home, 79% strongly or somewhat agreed that it made them feel safer, and 79% strongly or somewhat agreed they would recommend RPM to someone they know.
The authors concluded, “As total joint replacements are increasingly being performed in the outpatient setting, postoperative patient monitoring from home is a feasible way to help mitigate readmissions in the postoperative period. The utility of a virtual response center would be to identify, in real time, certain patient metrics that could indicate potential complications and ultimately allow for more timely intervention that may prevent morbidity and readmissions. Efforts to minimize costs should not be implemented at the expense of patients’ health outcomes with a goal to find an appropriate balance between both agendas.”1
Masimo SafetyNet is not intended to be used for real-time monitoring.
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