Routine Overnight Vital Signs Are Rarely Associated with Major Clinical Events in Patients Undergoing Radical...

Area of Science:

• Urology
• Surgical Oncology
• Critical Care Medicine

Background:

• Patient sleep disruption is linked to adverse clinical outcomes.
• Overnight vital sign checks frequently disrupt patient sleep.
• Radical cystectomy for bladder cancer is a major surgery with a significant recovery period.

Purpose of the Study:

• To evaluate the clinical utility of routine overnight vital sign checks in stable postoperative patients after radical cystectomy.
• To determine if reducing overnight vital sign monitoring is safe and feasible.

Main Methods:

• A retrospective database analysis of vital sign checks from postoperative days 0-6 for 546 patients undergoing radical cystectomy (2016-2020).
• Abnormal overnight vital signs were identified and reviewed for association with significant clinical interventions (Clavien-Dindo grade ≥II complications).

Main Results:

• Clinically significant events (moderate/major interventions) occurred in only 0.65% of patient-nights, requiring 152 nights of monitoring per event.
• Most Clavien-Dindo grade II complications (65%) presented without vital sign abnormalities.
• All grade ≥III complications were associated with vital sign abnormalities.

Conclusions:

• Routine overnight vital sign checks in stable postoperative patients after radical cystectomy yield a low frequency of clinically significant findings.
• Decreasing the intensity of overnight vital sign monitoring could be a safe component of enhanced recovery protocols for select patients.