The Connected Neurosurgical Patient

We asked DiffMed's speakers to send teasers of their talk before the conference. Here is a piece by Geoff Appelboom, Entrepreneur and Neurosurgeon.   

The overall rate of readmission within 30 days of hospital discharge is nearly 20%, and is causing an associated annual cost of more than $17.4 billion in the US alone. Indeed, thirty-day readmission is associated with increased patient morbidity, as well as a huge economic burden. Preventing avoidable readmissions has the potential to profoundly improve both the quality-of-life for patients and the financial well-being of healthcare systems. We conducted a longitudinal study from 2009 to 2012 within New York, and identified 163 743 neurosurgical patients out of which 14 791 (9.03%) readmitted within 30 days of initial discharge. The most common reasons for unplanned readmission were infection (29.52%) and medical complications (19.22%) considered for ambulatory management if diagnosed early, yet we are currently lacking novel strategies for early detection and action.

Innovations in mobile health and electronics are revolutionizing the involvement of both doctors and patients by extending the capabilities of physiological monitoring outside of the hospital. A number of wearable physiological monitoring systems have been developed to monitor a wide range of parameters. These “smart” wearable body sensors include a wide range of sensors such as accelerometers, gyroscopes environmental sensors packaged in smart fabrics, wristbands, necklaces and earrings. Triaxial accelerometers, for example, can monitor vibrations in three planes and can detect movement and posture, such as upright or lying down, time active or spine mobility according to the magnitude of acceleration signals along sensitive axes. The sensors can also be integrated into a user's clothing and provides guidance and feedback to the user on their smartphone generating warnings based on the user's level of recovery. Moreover, these new technologies allow for patient engagement and participation in their care, actively engaging them to participate to their recovery. Another interesting area of development for these connected body sensors is to detect early complication after surgery. Smart patches can track patient body temperature 24/7 wirelessly to detect post-operative infection; moreover bed sensors can inform nurses of patients at risk of pressure ulcers that require home interventions. 

The new world of stretchable and bioresorbable electronics are opening new avenues for patient monitoring and treatment. Ultrathin, bio-resorbable electronic tattooed on the skin are being developed to continuously monitor a wide range of parameters such as nerve and muscle activity. Another interesting new device is a resorbable electronic that can be implanted within the surgical site to wirelessly monitor surgical wounds and eliminate bacterial infection. This fully degradable, remotely controlled, implantable therapeutic device can be “turned on”, after implantation, when staphylococcus aureus is detected to prevent surgical site infection and the implant further disappears once its function is complete.6

Finally, another interesting device has been developed to potentially monitor postoperative spine surgery. The E-Dura, an electronic dura matter is a thin ribbon, with embedded electrodes, which lies along the spinal cord. It monitors local environment but can also delivers electrical impulses and different types of drugs (i.e. pain medications, antibiotics,..), while being supple enough to move like real human tissue.7 

In conclusion, new exciting opportunities afforded by connected wearable sensor and biocompatible electronics have the potential to profoundly affect spine treatments in the near future and the purpose of this presentation is to give you an idea of what can be done to improve patient care using connected devices.