Wearables & Orthopedics: Where’s the Potential?

The Affordable Care Act brings great change to the orthopedic sector, forcing surgeons to consider how value-based-care models will affect their practices. In a recent meta-analysis, 30-day readmissions for orthopedic surgery was measured at 5.4 percent.¹ At a recent Medical Development Group meeting in Boston, Mass., on the Internet of Things, the room was packed as several physicians presented multiple future clinical applications for wearable technologies.²

Why This Is Important
Twenty-four studies in the meta-analysis showed that the top three causes of 30-day readmissions were surgical site infection (32.2 percent), non-infectious wound problems, (14 percent) and surgical site complications (46.2 percent).³

Can Wearables Help Prevent Readmission Rates?
In the meta-analysis, risk factors positively associated with increased 30-day readmissions were age, length of hospital stay, discharge to a skilled nursing facility, increased body mass index, and an American Society of Anesthesiologists score of greater than^{4.5,6,7,8,9,10} Sepsis is a systemic inflammatory, progressive response to infection that, without intervention, can result in organ dysfunction and/or failure.¹¹ For treatment to be successful, early identification of patients at risk and needing intervention is critical.¹²

There are many studies that link surgical site infection to poor outcomes. In one study, total hospital stays were lengthened by approximately two weeks per patient, readmission rates almost doubled, and healthcare costs increased by more than 300 percent.¹³ Another documented knee replacement postoperative infection rates ranging from 0.68 to 1.60 percent, depending on patient risk, and hip replacement infection rates from 0.67 to 2.4 percent (see Chart 2).¹⁴

How Can Wearables Help Identify Post-Op At-Risk Patients?
If at-risk patients were discharged with wearables for early diagnosis of and treatment of conditions like sepsis, outcomes might be improved.¹⁶ The Systemic Inflammatory Response Syndrome (SIRS) is a condition used by healthcare providers to identify patients experiencing a clinical response to an infection, such as sepsis.¹⁷ SIRS is defined when patients present with two or more of the following symptoms:

• Temperature greater than 100.4 degrees Fahrenheit or less than 96.8 degrees Fahrenheit;
• Heart rate greater than 90 beats per minute;
• Respiratory rate greater than 20 breaths per minute or an arterial partial pressure of carbon dioxide less than 4.3 kPa (32 mmHg); and
• White cell count above 12,000 cells/mm3 or less than 4,000 cells/mm³

Although a simplistic solution that requires substantially more development, wearables can be configured to monitor the first three of the four SIRS symptoms. Wearables are ubiquitous, and the wearable device market is predicted to reach a value of $12.6 billion by 2018.¹⁸

Technology Prevails
Identifying at-risk patients is only one of the many potential uses for wearable technology. How can wearables help your physician customer better manage the health of its patient population? 

References

1. Bernatz JT, Tueting JL, Anderson PA (2015) Thirty-Day Readmission Rates in Orthopedics: A Systematic Review and Meta-Analysis. PLoS ONE 10(4): e0123593. doi:10.1371/journal.pone.0123593
2. www.mdgboston.org/events/event_details.asp?id=523509
3. Ibid
4. Ibid
5. Op.cit 1
6. Cullen C, Johnson DS, Cook G. Re-admission rates within 28 days total hip replacement. Ann R Coll Surg Engl. 2006; 9: 88(5):475–8.
7. Schairer WW, Carrer A, Deviren V, Hu SS, Takemoto S, Mummaneni P, et al. Hospital readmission after spine fusion for adult spinal deformity. Spine (Phila Pa 1976). 2013; 9: 38(19):1681–9.
8. Kocher RP, Adashi EY. Hospital Readmissions and the Affordable Care Act: Paying for Coordinated Quality Care. JAMA. 2011: 306(16):1794–1795. doi: 10.1001/jama.2011.1561
9. Joynt KE, Orav EJ, Jha AK. Thirty-day readmission rates for Medicare beneficiaries by race and site of care. JAMA. 2011; 2: 305(7):675–81. doi: 10.1001/jama.2011.123
10. Ibid
11. Scottish Intercollegiate Guidelines Network (SIGN). Postoperative management in adults : a practical guide to postoperative care for clinical staff. SIGN publication [Internet]. 2004; (77):
12. Ibid
13. Whitehouse JD, Friedman ND, Kirkland KB, Richardson WJ, Sexton DJ. The Impact Of Surgical Site Infections Following Orthopedic Surgery At A Community Hospital And A University Hospital: Adverse Quality Of Life, Excess Length Of Stay, and Extra Cost. Infect Control Hosp Epidemiol 2002;23:183-189.
14. Edwards JR, Peterson KD, Mu Y, Banerjee S, Allen-Bridson K, Morrell G, et al. National Healthcare Safety Network (NHSN) report: Data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783-805.
15. Ibid
16. Rivers EP, Ahrens T. Improving outcomes for severe sepsis and septic shock: tools for early identification of at-risk patients and treatment protocol implementation. Crit Care Clin 2008; 24(Suppl 3): 1-47.
17. Matot I, Sprung CL. Definition of sepsis. Intensive Care Med 2001; 27(Suppl 1): 3-9
18. www.statista.com/statistics/259372/wearable-device-market-value/

Editor’s note: Readers are invited to submit market data and trend questions to Maria Shepherd. Periodically, selected questions will be presented in this column, with answers from Maria.

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Maria Shepherd has 20 years of leadership experience in medical device/life-science marketing in small startups and top-tier companies. Following a career including roles as vice president of marketing for Oridion Medical (a company acquired by Covidien, which is now Medtronic), director of marketing for Philips Medical and senior management roles at Boston Scientific Inc., she founded Data Decision Group. Shepherd recently was appointed to the board of the ALIGO Healthcare Investment Committee. She can be reached at (617) 548-9892, [email protected], www.ddecisiongroup.com, or followed on Twitter @MedTechResearch.