Integrating a Multimodal Digital Device for Continuous Perioperative Monitoring in Patients With Lung Cancer Undergoing Thoracic Surgery: Development and Usability Study.

Background: Minimally invasive thoracic surgery has improved lung cancer outcomes but requires enhanced postoperative care. Traditionally, the episodic care model has limited timely and multidimensional monitoring of patients. Recent technological advances in multimodal digital devices, including wearable devices and electronic patient-reported outcomes (ePROs), offer a promising solution to these challenges. However, current studies focus on only a few parameters and limited application in thoracic surgery.

Objective: This study aims to propose a self-controlled study to evaluate the feasibility and reliability of multimodal digital devices, including wearables and ePROs, for continuous perioperative monitoring to enhance recovery after thoracic surgery.

Methods: We included 288 patients with non-small cell lung cancer from the Guangzhou Medical University cohort, which includes 2757 participants with various lung diseases. Digital data were collected during hospitalization using a commercial smartwatch combined with an ePROs questionnaire, while clinical data were obtained from electronic health records (EHRs). Agreement between the digital device and EHR was evaluated via Bland-Altman analysis. Time-series data were normalized for continuous outlier monitoring, and threshold analysis of ePROs scores were used to explore associations across different modules.

Results: Throughout hospitalization, digital devices provided a subjective overview of the patients' recovery trajectories. Results of Bland-Altman analysis demonstrated a high level of agreement between the digital device and the EHR. For body temperature, the analysis revealed a minimal bias of 0.02 °C (95% CI -0.01 °C to 0.05 °C), the agreement for heart rate showed a bias of 0.26 beats per minute (bpm; 95% CI -0.49 bpm to 1.01 bpm), and the bias for oxygen saturation was -0.06% (95% CI -0.27% to 0.15%), indicating close alignment between the 2 measurement methods. Meanwhile, wearable devices demonstrate significant potential in outlier detection compared to the episodic care model, offering accurate and sensitive monitoring of outliers between traditional measurement intervals. Using a thresholding method, we found that wearable metrics were correlated with the severity of ePROs.

Conclusions: These findings highlight the reliability and clinical potential of digital device-based multimodal systems within the enhanced recovery after surgery framework, offering a novel approach for continuous perioperative monitoring.