Patients continuously monitored after surgery experienced significantly less time with dangerously low oxygen levels compared to those monitored using routine spot checks, a new study from Wake Forest University School of Medicine found.
The study, which took place at Atrium Health Wake Forest Baptist Medical Center, was published Tuesday in JAMA Network Open.
The research represents the first large, randomized crossover trial and largest dataset to date evaluating continuous wearable monitoring technologies on hospital surgical floors.
Even modest amounts of hypoxemia may meaningfully affect recovery and could possibly be an early indicator of a downstream clinical event. This trial shows that real-time visibility into patient physiology helps teams respond sooner and more effectively. While our work was not powered for patient centric outcomes, those point estimates are encouraging and should motivate the scientific community to conceive larger pragmatic trials with hard outcomes.”
Ashish K. Khanna, M.D., professor of anesthesiology and vice chair of research at Wake Forest University School of Medicine and lead author of the study
Researchers compared standard intermittent vital sign checks, typically every four hours, with a novel continuous wearable monitoring system that recorded a multitude of vital signs. Those included oxygen saturation, heart rate and blood pressure every 15 seconds.
The trial was conducted across two postoperative surgical units, which alternated monitoring methods every four weeks over a full year. Nearly 3,700 patients, including 800 high-risk patients, were included in the primary analysis.
Key findings
Reduced hypoxemia: Continuously monitored patients spent approximately 30 fewer minutes with oxygen saturation below 90%, a statistically significant 14% risk reduction for dangerous desaturation events. In addition, composite outcomes including combinations of desaturation, heart rate or blood pressure changes were significantly improved by continuous monitoring. Lower oxygen levels after surgery can delay recovery and increase the patient’s risk of complications.
Trends toward overall safety improvement: Although not statistically significant individually, continuously monitored patients experienced fewer ICU transfers, fewer rapid response activations and lower in-hospital mortality.
According to Khanna, Atrium Health Wake Forest Baptist Medical Center is the only large U.S. hospital to have successfully deployed this continuous monitoring technology and to have done this type of trial at scale.
Traditional vital sign checks every four to six hours on the general inpatient nursing units often fail to capture early deterioration. Wearable continuous monitoring provides clinicians with real-time alerts, enabling earlier interventions.
Researchers noted earlier bedside interventions, including airway repositioning, stimulation and supplemental oxygen, likely contributed to improved outcomes.
With hundreds of millions of surgeries performed worldwide each year, the postoperative period remains one of the most vulnerable times for patients. Continuous wearable monitoring offers a scalable, feasible pathway to improving outcomes and reducing preventable complications.
“This study provides an important push for the worldwide surgical and perioperative community,” Khanna said. “Continuous wearable monitoring is no longer experimental. It’s achievable, impactful and ready for broader adoption.”
This study was supported by NIH grant UL1TR001420.
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