Background: Continuous monitoring of patients’ vital signs is critical for early detection of postoperative complications. Traditional manual monitoring by nursing staff is time-consuming and provides only intermittent data. Wearable devices offer continuous monitoring capabilities, potentially enhancing early warning systems, reducing nurse workload, and facilitating earlier patient discharge. However, research on their implementation and effectiveness in clinical settings remains limited. Objective: This study aims to evaluate the implementation and feasibility of continuous monitoring using photoplethysmography sensor technology (a viQtor device) in a surgical ward. We will also assess the impact on nursing workload and the usability of this workflow. Methods: The REQUEST (Remote Monitoring by viQtor Upon Implementation on a Surgical Department) study is a prospective observational implementation study conducted over 8 months in a surgical ward. The vital signs of 500 postoperative patients will be continuously monitored using the viQtor device, which measures heart rate, respiratory rate, and oxygen saturation. The study consists of 2 phases: an initial period with manual spot checks, followed by a phase using the wearable device as the primary monitoring tool. Outcomes include the Integrated Workload Scale for nursing workload and a framework evaluating acceptability, feasibility, adoption, and sustainability. Data collection involves device performance metrics, questionnaires (the Evidence-Based Practice Attitude Scale and the System Usability Scale), and thematic analysis of focus groups. Results: Staff training was completed in October 2024, and full implementation is ongoing. Preliminary findings, including data on usability and workload, are expected by July 2025. Conclusions: This study will provide insight into the practical implementation of continuous vital sign monitoring in surgical care. The findings may support future adoption of wearable technology in clinical workflows. Trial Registration: ClinicalTrials.gov NCT06574867; https://clinicaltrials.gov/study/NCT06574867 International Registered Report Identifier (IRRID): DERR1-10.2196/70707

Objective: Vulvar cancer surgery is associated with high postoperative wound complication rates. Reconstructive surgery (RS) in vulvar cancer is generally reserved for surgery of extensive tumors or local recurrences. The primary aim of the study is to determine the incidence and risk factors for wound complications after vulvar cancer surgery. As a secondary aim, we compare the effects of primary closure (PC) versus reconstructive surgery on wound complications. Methods: In a retrospective cohort study in four gynecologic oncology centers in the Netherlands, patients undergoing surgical treatment (2018–2022) for vulvar cancer were included. Wound complications after PC and RS and risk factors associated with complications were analyzed by using logistic regression adjusting for confounds. Results: We included 394 women, 318 with PC and 76 with RS. The incidence of wound complications was 46.7%, with 42.4% of wound breakdowns comprising the majority of complications. The use of RS was associated with an increased risk of wound complications. Larger tumor size, proximity to the urethra, resection of the urethra during surgery, and perineal tumor location were additional risk factors for wound complications. However, after multivariate analyses, RS remained the only significant risk factor (OR 1.2; 95% CI 1.1–1.2). Conclusions: Risk factors for wound complications after vulvar cancer surgery include larger tumor size, proximity to the urethra, resection of the urethra during surgery, and perineal tumor location. RS is also associated with an increased risk of wound complications, probably related to case selection.

Background: Continuous monitoring of vital signs using wearable devices may improve early detection of postoperative complications and reduce nursing workload. Evidence from real‐world clinical implementation remains limited. This study aimed to answer the question: does the implementation of wearable monitoring in surgical wards reduce nursing workload and is it feasible and acceptable to staff? Methods: A prospective, single‐center implementation study was conducted on a surgical ward in a large teaching hospital. Nursing workload was assessed using the Integrated Workload Scale (IWS), and usability was evaluated using the system usability scale (SUS). Additionally, staff attitudes were measured with the evidence‐based practice attitude scale (EBPAS). Manual spot checks of vital signs were monitored before and after the implementation of wearable devices (viQtor) for continuous monitoring of heart rate, respiratory rate, and oxygen saturation. Results: Nursing workload decreased significantly with mean IWS scores dropping from 5.46 ± 1.18 to 3.87 ± 1.38 ( p < 0.001). A 62.7% reduction in manual spot checks was observed (from 4686 expected to 1748 performed, p < 0.001) corresponding to a time saving of 10.1 min per patient per day. The SUS score improved from 74.2 ± 10.1 to 86.0 ± 5.2 ( p = 0.025). No significant differences were observed in EBPAS scores over time ( p = 0.43). Conclusions: Implementation of remote wearable monitoring in surgical wards is feasible, reduces nursing workload, and demonstrates high usability and acceptance among staff. These findings highlight the potential of wearable technology for more efficiency of postoperative care. Trial Registration: ClinicalTrials.gov: NCT06574867, prospectively registered on 27 August 2024

Early detection of clinical deterioration on surgical wards is vital to prevent adverse outcomes. Conventional ward monitoring using the Modified Early Warning Score (MEWS) relies on intermittent nurse-measured vital signs, but its role may change when continuous wearable monitoring is already available. This study evaluated the transition from mandatory to discretionary nurse-measured MEWS assessment in a continuously monitored surgical ward and compared the diagnostic performance of two wearable-derived Early Warning Scores (EWS) with conventional MEWS. In this single-center cohort study conducted between October 2024 and June 2025, postoperative patients were continuously monitored using a wearable sensor measuring heart rate, respiratory rate, and oxygen saturation. Continuous wearable monitoring was available throughout the entire study period. During Phase 1, nurse-measured MEWS assessments were mandatory according to local protocol. During Phase 2, nurse-measured MEWS assessments were performed at staff discretion. Two wearable-derived algorithms were evaluated: the Continuous Remote EWS (CREWS), based on a previously developed algorithm, and Remote 3 EWS (R3EWS), a modified version of the hospital’s standard MEWS using three parameters. The primary outcome was diagnostic accuracy for clinical deterioration, defined as postoperative complications graded Clavien–Dindo ≥ II. A total of 544 admissions (516 patients) were included, of which 98 admissions (18%) experienced clinical deterioration (comprising 154 clinical deterioration events). Following the transition from mandatory to discretionary nurse-measured MEWS assessment, intermittent nurse-measured vital signs were performed less frequently, while MEWS ≥ 3 occurred more often, resulting in higher MEWS sensitivity and lower specificity. In the separate diagnostic performance analysis, R3EWS showed slightly higher AUROC values (0.61) compared with MEWS (0.58) and CREWS (0.59), although differences were modest. Wearable-derived alarm frequency increased 6–8 h before clinical deterioration. In a surgical ward where continuous wearable monitoring was already available, transition from mandatory to discretionary nurse-measured MEWS assessment was associated with fewer intermittent observations, higher MEWS sensitivity, and lower specificity. Wearable-derived EWS algorithms showed comparable but modest discriminative performance relative to conventional MEWS. The increased number of alerts highlights the need for prospective validation and clear protocols for integrating continuous monitoring data into ward escalation workflows.

BACKGROUND Continuous monitoring of patients’ vital signs is critical for early detection of postoperative complications. Traditional manual monitoring by nursing staff is time-consuming and provides only intermittent data. Wearable devices offer continuous monitoring capabilities, potentially enhancing early warning systems, reducing nurse workload, and facilitating earlier patient discharge. However, research on their implementation and effectiveness in clinical settings remains limited. OBJECTIVE This study aims to evaluate the implementation and feasibility of continuous monitoring using photoplethysmography sensor technology (a viQtor device) in a surgical ward. We will also assess the impact on nursing workload and the usability of this workflow. METHODS The REQUEST (Remote Monitoring by viQtor Upon Implementation on a Surgical Department) study is a prospective observational implementation study conducted over 8 months in a surgical ward. The vital signs of 500 postoperative patients will be continuously monitored using the viQtor device, which measures heart rate, respiratory rate, and oxygen saturation. The study consists of 2 phases: an initial period with manual spot checks, followed by a phase using the wearable device as the primary monitoring tool. Outcomes include the Integrated Workload Scale for nursing workload and a framework evaluating acceptability, feasibility, adoption, and sustainability. Data collection involves device performance metrics, questionnaires (the Evidence-Based Practice Attitude Scale and the System Usability Scale), and thematic analysis of focus groups. RESULTS Staff training was completed in October 2024, and full implementation is ongoing. Preliminary findings, including data on usability and workload, are expected by July 2025. CONCLUSIONS This study will provide insight into the practical implementation of continuous vital sign monitoring in surgical care. The findings may support future adoption of wearable technology in clinical workflows. CLINICALTRIAL ClinicalTrials.gov NCT06574867; https://clinicaltrials.gov/study/NCT06574867 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/70707

Background: Early Warning Scores (EWS) are widely implemented to identify clinical deterioration in hospitalized patients. However, their accuracy remains limited by intermittent vital sign measurements and high false-positive rates. Continuous monitoring with wearable sensors offers more timely detection, and integrating laboratory parameters may further enhance predictive precision. This study evaluated whether combining continuous vital sign monitoring with routine laboratory tests improves the prediction of postoperative complications compared with standard EWS approaches. Methods: All adult patients admitted in 2023 to the surgical oncology ward of Catharina Hospital Eindhoven who underwent monitoring with a wireless accelerometer patch were included. Continuous heart and respiratory rate data were combined with laboratory parameters, including C-reactive protein (CRP) and leukocyte count. Postoperative complications (Clavien–Dindo ≥ II) were identified by chart review. Logistic regression was used to identify significant predictors and to construct the CLUE model (Combining Labdata Upgrading Early warning scores). Model performance was compared with the Continuous Remote Early Warning Score (CREWS) using the area under the receiver operating characteristic curve (AUC). Results: The final dataset included 198 complete observations from 155 patients. Heart rate, CRP, and leukocyte count were independently associated with postoperative complications. The CLUE model achieved an AUC of 0.71 (0.60-0.80) outperforming the CREWS model (AUC 0.57 (0.50-0.63)). Conclusion: Integrating laboratory data with continuous vital sign monitoring improved the discrimination of postoperative complications compared with vital sign based EWS alone. The CLUE model represents a clinically interpretable step toward more precise, multimodal early warning systems.