Real-time Evaluation and Continuous Observation of Vital Signs for Enhanced Recovery: a Study for the Early Identification of Complications in the Surgical Ward Following Surgery in Patients Not Eligible for Intensive Care Admission.

The RECOVER study evaluates the use of continuous wearable monitoring in surgical ward for the early detection of postoperative complications in patients recovering after major surgery. The study begins with the evaluation of urologic surgery. It focuses on whether continuous measurement of vital signs in the surgical ward can identify clinical deterioration and postoperative complications earlier than routine postoperative surveillance alone: postoperative complications are often preceded by changes in vital signs and may develop during the first days after surgery, when patients are usually monitored intermittently in the ward. Continuous wireless monitoring is intended to provide earlier recognition of respiratory and hemodynamic deterioration while patients recover outside the operating room and outside intensive care.

The main objective is to assess whether continuous monitoring of vital signs can detect early signs of medical or surgical postoperative complications after moderate-to-high complexity urologic surgery performed under general anesthesia. The protocol is particularly focused on identifying episodes of desaturation, tachypnea, hemodynamic instability, and persistent deviation of vital signs from patient's baseline values during the postoperative period.

Patient enrollment takes place in the Urology ward before the scheduled operation. During the preoperative anesthesiology evaluation, the anesthesiologist provides study information and asks the patient to participate by signing informed consent and personal data processing forms. This enrollment process is maintained in both patient pathways described in the protocol.

For patients managed with continuous monitoring, the wearable system is applied on the evening before surgery so that baseline vital sign values can be collected under resting conditions. Monitoring is interrupted before transfer to the operating room and restarted after the patient returns from surgery to the ward. The patient then wears the system for at least 72 hours after surgery, and the device does not replace standard postoperative monitoring.

The wearable platform used in the protocol is the Portrait Mobile® system by GE HealthCare. It continuously records respiratory rate, oxygen saturation, and heart rate, while blood pressure and EKG continues to be measured intermittently according to usual ward practice in order to maintain the non-intensive care settings and the actual patient-nurse ratio. Data are transmitted through the hospital Wi-Fi network to a dedicated monitoring infrastructure, where alarms can be visualized on the ward monitoring station.

Alarm thresholds are predefined by the investigator using values derived from the National Early Warning System Score. These thresholds include respiratory rate below 11 or above 21 breaths per minute, oxygen saturation below 95%, and heart rate below 50 or above 91 beats per minute. In addition to threshold-based events, the protocol evaluates persistent deviation from baseline, defined as a change greater than 20% for at least 24 hours, in order to capture clinically meaningful trends rather than isolated abnormal values.

When an alarm is generated, ward nursing staff are asked to determine whether the alert is appropriate or represents a false positive. They also record whether the patient is at rest or moving at the time of the alert, allowing the investigators to assess device performance under real clinical conditions. Subsequent clinical actions, including review by the ward physician, on-call physician activation, or request for anesthesiology consultation, are reconstructed from nursing handover and the clinical chart.

For patients managed with usual postoperative surveillance alone, enrollment still occurs during the preoperative anesthesiology assessment and clinical data are collected after informed consent is obtained. These patients receive standard ward monitoring without wearable continuous monitoring, and their postoperative course is documented for comparison of clinical events and outcomes.

The primary endpoints are the number of desaturation events, tachypnea events, and hemodynamic instability events. Secondary endpoints include false positive rate, number of physician alerts, number of requests for intensive care consultation, unplanned intensive care admission directly from the operating area, transfer to intensive care during postoperative ward stay, postoperative complications, re-surgery, correlation between parameter trends and outcomes, hospital length of stay, barriers to rehabilitation, patient satisfaction, and integration of the system with the hospital IT infrastructure.

All complications will be recorded in the case report form and graded according to the Clavien-Dindo classification. Collected data include baseline patient characteristics, average preoperative vital sign values, diagnosis, type of surgery, intraoperative data, continuous monitoring data, postoperative clinical course, pain, functional recovery, total hospital stay, ICU stay, and patient satisfaction with the monitoring system.

The system is not expected to expose patients to additional risk and does not interfere with the usual diagnostic and therapeutic pathway. Wireless wearable monitoring should not negatively affect mobilization, rehabilitation, or functional recovery, which is relevant because preservation of postoperative recovery is one of the practical concerns addressed by the study.

• False-positive rate [Time frame: 72 hours after the surgery]
• Number of on-call doctor call-outs [Time frame: 72 hours after the surgery]
• Number of requests for Anesthesia consultation [Time frame: 72 hours after surgery]
• Unscheduled direct admission to the Intensive Care Unit from the operating theatre and unplanned transfer to the Intensive Care Unit during the post-operative period (from the surgical ward) [Time frame: 72 hours after surgery]
• Occurrence of post-surgical complications (any type) or reoperation [Time frame: 72 hours after surgery or patients discharge]
• Correlation between parameters trend, including persistent deviation from pre-operative values, and patient outcome or length of hospital stay. [Time frame: Untill patient discharge from hospital]
• Barriers to patient rehabilitation and patients satisfaction [Time frame: 72 hours after surgery or discharge]