Evaluation of a Telemedicine System for Patients Carried for Bariatric Surgery

The evolution of the health system requires a rationalization of the supply of care and the care of patients. It has allowed the evolution and generalization of ambulatory surgery for certain pathologies. For other pathologies, a hospital stay is still desirable with a tendency to decrease the length of stay. Thanks to the telemedicine platforms, specialized medical monitoring can be extended pre- and post-operatively to ensure good patient preparation and quality secure follow-up.

Early return to home is an essential parameter in optimizing the distribution of hospital resources. Several studies have shown improved clinical outcomes, fewer complications, more beds available, and lower hospital costs. The development of outpatient surgery has enabled the establishment of systems allowing a return home in secure conditions. Early return home is also a wish of the patient. He becomes an actor of his own health. Obesity surgery is an exemplary specialty for the care of patients. The ideal course of care is perfectly codified both preoperatively and postoperatively. Nevertheless, this ideal care path is not always respected especially in structures too small to offer a real integrated multidisciplinary follow-up. Pre- and postoperative management solutions on the Internet exist but require a voluntary and active adherence of the patient. They allow a stronger involvement of the patient in his approach, they are nascent and integrate no connected solution for automated monitoring of the patient. Telemedicine can now allow continuous monitoring without the need for face-to-face interaction. The automatic collection of the physical activity and the heart rate makes it possible to guarantee the involvement of the patient in his preparation. After the intervention, the monitoring of the occurrence of complications can be delegated to connected objects with alert transmission according to parameters defined in advance. In particular, the heart rate is a sensitive indicator and will be followed by two sensors (activity bracelet and pulse oximeter). These complications occur mainly in the 15 days following the intervention, they are rare in immediate postoperative. The hospital stay is no longer necessary for a simple surveillance. In case of receipt of an alert, the surgeon contacts the patient to check his state of health. An adapted action is then engaged.

The late postoperative follow-up throughout this document corresponds to the phase following the immediate postoperative phase. This late postoperative follow-up can be improved with the support of telemonitoring (activity, change in weight.) The addition of connected devices allows a stronger and faster interaction between the patient and his doctors, providing close monitoring and appropriate support.

The study focuses on assessing the reliability of a remote monitoring system. The implementation of this remote monitoring system is subordinated to the reliability of the data transmissions between the connected objects and the remote site which receives the data, interprets them and generates the alerts.

The motivation of the patient is appreciated by the acceptance of connected objects.

During this study, the remote monitoring system is offered in addition to the usual care. The usual care does not change and is not impaired. This study concerns only one group of patients, there is no control group since the investigators seek to validate the reliability of remote surveillance.

Inclusion criteria

• Patient (s) applying for bariatric surgery
• Patient aged 18 to 65
• Compliance with the High Authority of Health (HAS) criteria:

• BMI> 40 without comorbidities
• BMI> 35 with cardiovascular, metabolic, respiratory or rheumatic comorbidity,
• Psychological follow-up well followed for 4 to 6 months
• Patient with an ASA (American Society of Anesthesiologists) score less than or equal to 2
• Patient able to receive and understand information about the study
• Patient able to manipulate connected objects
• Patient (e) affiliated to the French social security system
• Patient who does not live in the white area of wireless telephone coverage.

Exclusion criteria

• Patient unable to give informed consent
• Patient unable to use the connected tools (Internet)
• Patient whose general condition is not favorable to participation in the study
• Patient presenting, in the opinion of the investigator, a condition that may prevent participation in the procedures provided for in the study
• Patient in exclusion period (determined by previous or current study)
• Patient under the protection of justice
• Patient under guardianship or trusteeship
• Patient with epilepsy
• Patient who is sensitive to light flashes
• Patient with deformity of the ear
• Patient with bleeding ear

Exclusion criteria

• Patient whose home is in a white GSM (Global System for Mobile Communications) zone or white zone in reception and 3G (third generation) transmission
• Patient (e) not knowing how to use connected objects.