Philippe Topart, MD, Carine Phocas, RN. Clinique de l’Anjou
Objective
Although large published series have shown that at least 84% of the patients could be discharged within 23 hours of a laparoscopic Roux-en-Y gastric bypass (RYGB), a 2 or 3 day hospital stay is still considered the norm. Although no difference has been shown by 2 recent database studies regarding readmissions or complications between a 23 hour or a 2 day stay, the mortality risk could be higher for a <1 day stay. Since pulse rate and in a much lesser extent body temperature are the signs of complication, their monitoring is essential.
Methods
We are evaluating within our <24 hour stay RYGB program, the Fastpath solution developed by BePATIENT. This solution is based on a web platform, a mobile application and the Vitalconnect HealthPatch® disposable biosensor. This FDA (Class II 510k) and CE cleared device transmits several biometric parameters in real time and is made of a reusable sensor module and a silicone disposable patch placed on the patient’s chest. The HealthPatch® is paired using Bluetooth 4.0 to a web connected iOS 7.1 or later device. The zinc-air battery life ranges from 48 to 72 hours. We are currently using the BePATIENT Fastpath solution which records heart rate (beats/mn), respiration (cycles/mn), skin temperature (C°) and activity (number of steps). Once the patient is anonymously registered on BePATIENT’s platform and the patch has been connected to the smartphone, live biometric parameters are monitored online. The solution is fully customisable online: lower and upper normal values, frequency of recordings as well as recording intervals once an abnormal event has been detected. Email alerts can be sent after a specific number of abnormal events.
Results
Our configuration is given in table 1. We have used HealPatch® in 8 RYGB patients: 5 had an ambulatory surgery, 3 were discharged on day 1. 1 patch disconnected early and could not be reconnected. There was another temporary disconnection. Most alerts concerned the skin temperature. In 1 case, 2 periods of tachycardia (11 and 21 minutes) were observed the morning after an ambulatory RYGB. 1 patient with a normal recording had a complication (day 25 from surgery).
Conclusion
Despite minor connectivity issues and lack of accuracy of skin temperature, the HeathPatch® combined to the mobile device application is a unique method of remote monitoring after early discharge from a major surgical procedure. The main limitation is the lack of compliant smartphones at present. This situation should improve in the coming months with an Android application as well as a wider availability of Bluetooth 4.0 compliant mobile devices on the consumer market.
| min | max | basic recording interval | recording interval after abnormal event | number of abnormal events before alert | |
| heart rate (beats/mn) | 40 | 110 | 30 | 10 | 3 |
| respiratory frequency (cycles/mn) | 5 | 30 | 30 | 10 | 2 |
| skin temperature (C°) | 28 | 36 | 60 | 15 | 3 |