Wearable Technology in Surgery: New Developments Toward Real-Time Patient Monitoring

Abstract

Wearable technology refers to mobile electronic devices worn on the body to collect health-related data in real time. These devices, ranging from smartwatches to biosensors, are beginning to be integrated into surgical care for preoperative risk stratification, postoperative monitoring, and patient engagement. While these tools offer exciting possibilities—particularly in remote monitoring and real-time feedback—their integration into surgical workflows remains incomplete, and their clinical benefit remains largely unproven. This perspective focuses on patient-worn devices in the perioperative period and highlights current applications, barriers to adoption, and the critical gap between technological capability and validated patient outcomes.

Wearable devices are emerging as valuable tools in preoperative risk assessment by enabling continuous, non-invasive monitoring of physiological parameters such as heart rate, physical activity, and temperature. While commercial wearables may not match the precision of dedicated medical monitors, their widespread availability and affordability make them attractive adjuncts for evaluating baseline functional status and patient fitness for surgery.

The WELCOME study recently demonstrated that physical activity metrics obtained from commercial wearable devices significantly correlated with the six-minute walk test [1]. In addition, a small trial has demonstrated that wearable devices used for prehabilitation before major abdominal cancer surgery improved functional capacity, supporting their role in prehabilitation [2]. Wearable ECG devices have become highly accurate with respect to heart rhythm analysis, enabling the identification of cardiac abnormalities such as atrial fibrillation, which is predictive of perioperative complications—suggesting potential value in preoperative screening [3].

Patient-worn wearables are increasingly used to support disease monitoring in the perioperative setting, particularly for chronic comorbidities that influence surgical risk. The most common commercial tool used for disease control assessment is in the field of diabetes. Continuous glucose monitors offer real-time glucose data and have been shown to improve glycemic control compared to intermittent blood glucose measurements. Initially designed for community use, efficacy has also been demonstrated in hospital settings [4]. However, the intraoperative feasibility of continuous glucose monitoring remains uncertain due to concerns about potential interference from surgical equipment such as diathermy and radiation, requiring further research to evaluate technical reliability and accuracy in this context [5].

Wearables such as smartwatches can improve medication adherence by providing scheduled reminders and incorporating AI-based software that recognizes medication-taking behavior through motion detection. In one study, this system identified when patients missed their medication for two consecutive days, triggered alerts to physicians, and sent automated reminders to the patient—leading to a statistically significant improvement in adherence [6].

Wearable devices are playing an expanding role in postoperative care, allowing for continuous and remote monitoring of health parameters, in particular, with physical activity and gait. A reduced step count (as monitored by wrist- and ankle-mounted activity trackers) in the immediate postoperative period has been shown to be predictive of readmission after abdominal and cardiovascular surgeries [7-9]. Wearable fall-detection systems now use inertial sensors for continuous gait analysis and early fall prediction, improving patient safety during recovery [10].

A randomised controlled trial has demonstrated that continuous monitoring with a wireless chest-worn patch in surgical ward patients reduced time to antibiotic therapy after early signs of sepsis, shortened hospital stay, and lowered 30-day re-admission rates [11]. However, robust data demonstrating reductions in complication rates remain lacking.

Advancements in wearable technology, including lightweight smartwatches with enhanced battery life, graphene-based epidermal sensors, and textile-integrated monitoring systems, are driving healthcare innovation [12]. For example, implantable biosensors and soft wearable ultrasound devices are emerging for internal, real-time physiological monitoring [13]. Additionally, fibre-optic-based continuous blood pressure monitors and textile-integrated systems are improving remote monitoring accuracy [14].

The integration of artificial intelligence (AI) has significantly expanded the potential of wearable technology through analysis of patterns, detecting subtle abnormalities as well as identifying at-risk groups of patients [15, 16]. The convergence of wearable technology and AI holds substantial promise for identifying early postoperative complications.

Despite early promise, it is important to acknowledge that most wearable-based monitoring tools currently serve as continuous screening devices rather than validated interventions. There is a lack of robust evidence demonstrating that continuous monitoring using wearable technology improves clinical outcomes such as complication rates, return to theatre, or quality-adjusted life years (QALYs). Continuous monitoring in unselected patient populations may lead to overdiagnosis, generating incidental findings that provoke unnecessary investigations and potential harm [17]. These limitations highlight the need for carefully designed trials to establish the clinical value of wearables and to guide appropriate interpretation of the data they provide.

Additionally, data protection and privacy concerns must be addressed to ensure the secure transmission and storage of sensitive health data. Connectivity into EMR systems and reliability issues, including Bluetooth signal disruptions in clinical environments, pose challenges to seamless integration. Patient education and compliance are crucial, as efficacy depends on proper usage and adherence. Additionally, the cost and accessibility of these technologies remain an obstacle, particularly in resource-limited settings.

As costs decrease and technology advances, wearable devices have the potential to become a valuable adjunct in surgical care. The shift from passive data collection to AI assisted monitoring represents a meaningful evolution in how perioperative care may be delivered. However, the current evidence base remains limited. Until further evidence emerges, wearable technology should be thoughtfully integrated where appropriate to complement—not replace—standard perioperative assessment.

Surgeons can play a role in supporting robust research, ensuring responsible data use, and are well placed to advise patients on the potential benefits—and current limitations—of using their smart devices in the perioperative period. Ultimately, ongoing research will be critical in fully harnessing the potential of wearable technology to enhance surgical outcomes and patient safety.

The authors declare no conflicts of interest.