A yearlong trial at Atrium Health Wake Forest Baptist found that surgical patients wearing continuous monitors spent far less time with dangerously low oxygen levels than those checked only every few hours. The findings suggest a practical way to catch complications earlier and make hospital recovery safer.
A simple wearable device that tracks vital signs around the clock helped surgical patients spend far less time with dangerously low oxygen levels than patients checked only every few hours, according to a new study from Wake Forest University School of Medicine.
The yearlong trial, conducted at Atrium Health Wake Forest Baptist Medical Center and published in JAMA Network Open, is the first large, randomized crossover study and the largest dataset to date to test continuous wearable monitoring on hospital surgical floors.
Researchers compared the current standard of care — nurses checking vital signs intermittently, typically every four hours — with a continuous monitoring system that recorded oxygen saturation, heart rate and blood pressure every 15 seconds. The system alerted clinicians in real time when patients began to deteriorate.
The difference was striking. Patients who were continuously monitored spent about 30 fewer minutes with oxygen saturation below 90%, a level considered dangerously low. That translated into a statistically significant 14% reduction in the risk of desaturation events.
Even small dips in oxygen can matter, according to lead author Ashish K. Khanna, a professor of anesthesiology and vice chair of research at Wake Forest University School of Medicine.
“Even modest amounts of hypoxemia may meaningfully affect recovery and could possibly be an early indicator of a downstream clinical event,” Khanna said in a news release.
Low oxygen levels after surgery can slow healing, increase the risk of complications and, in severe cases, lead to organ damage or death. On busy hospital floors, however, subtle warning signs can be missed when vital signs are checked only a few times a day.
Traditional checks every four to six hours often fail to capture early deterioration between visits. In contrast, the wearable system gave care teams a continuous stream of data and real-time alerts, allowing them to intervene sooner.
The trial enrolled nearly 3,700 postoperative patients across two surgical units, including about 800 considered high risk. The units alternated between standard intermittent checks and continuous wearable monitoring every four weeks over the course of a full year, allowing the researchers to compare outcomes under both approaches in the same hospital environment.
In addition to reducing time spent with low oxygen, the continuous monitoring group showed significantly better composite outcomes that combined desaturation with changes in heart rate or blood pressure. These combined measures are often used to capture overall physiologic instability.
Although the study was not designed to definitively prove improvements in major outcomes such as deaths or intensive care unit transfers, the researchers saw encouraging trends. Patients with continuous monitoring had fewer ICU transfers, fewer rapid response activations and lower in-hospital mortality, though these differences did not reach statistical significance on their own.
Khanna emphasized the ability to see what is happening with a patient’s vital signs in real time appears to be key.
“This trial shows that real-time visibility into patient physiology helps teams respond sooner and more effectively. While our work was not powered for patient centric outcomes, those point estimates are encouraging and should motivate the scientific community to conceive larger pragmatic trials with hard outcomes,” he said.
The team reported that earlier bedside interventions — such as repositioning a patient’s airway, stimulating them to take deeper breaths or providing supplemental oxygen — likely contributed to the improved physiologic outcomes. These are relatively simple actions that can prevent a mild problem from becoming a crisis if they are done early enough.
Atrium Health Wake Forest Baptist Medical Center is currently the only large U.S. hospital to have successfully deployed this type of continuous wearable monitoring technology on surgical floors and to test it at scale in a randomized trial, according to Khanna.
The stakes are high. Hundreds of millions of surgeries are performed worldwide each year, and the hours and days after an operation remain one of the most vulnerable periods for patients. Complications can develop quickly, especially at night, when staffing is leaner and patients may be sedated or in pain.
Continuous wearable monitoring offers a way to extend intensive-care-style vigilance to regular hospital wards without requiring intensive-care-level staffing. Small, wireless sensors can track vital signs continuously and send alerts to nurses’ stations or mobile devices when readings drift into dangerous territory.
Because the technology is scalable and designed to fit into existing workflows, the researchers say it could be adopted more widely to reduce preventable complications and make recovery safer for large numbers of patients.
“This study provides an important push for the worldwide surgical and perioperative community,” Khanna added. “Continuous wearable monitoring is no longer experimental. It’s achievable, impactful and ready for broader adoption.”
The study, according to the authors, sets the stage for larger, multi-center trials focused on hard outcomes such as deaths, ICU admissions and long-term recovery.
For now, the findings suggest that something as simple as a wearable sensor and a continuous data feed could help hospitals catch trouble earlier — and give surgical patients a safer path from the operating room to home.