Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
Health System Information Resources, University of Texas Southwestern Medical Center, Dallas, Texas.
Urol Pract. 2022 Mar;9(2):150-157. doi: 10.1097/UPJ.0000000000000289. Epub 2021 Dec 7.
Evidence has associated patient sleep disruption with adverse clinical outcomes. Overnight vital sign checks are a frequent source of patient sleep disruption. We sought to determine the utility of routine overnight vital sign checks in stable postoperative patients following radical cystectomy for bladder cancer.
We assembled a database containing all routine vital sign checks from postoperative days 0 through 6 for all patients who underwent radical cystectomy at our institution during a 5-year period (2016-2020). Sets of overnight vital signs were flagged as "abnormal" based on specified criteria and then reviewed by 2 blinded reviewers to determine whether they were associated with significant clinical interventions.
A total of 546 patients representing 2,589 patient-nights in the hospital were included. Abnormal vital signs resulting in "moderate" or "major" clinical interventions (corresponding to concern for Clavien-Dindo grade ≥II complications) occurred during 17/2,589 (0.65%) patient-nights. Thus, 152 patient-nights of routine vital sign checks were required to identify a single moderate or major clinical event. Reviewing all overnight-onset complications, we noted that a majority (15/23, 65%) of Clavien-Dindo grade II complications were manifested only by symptoms or laboratory abnormalities without vital sign derangements, whereas all grade ≥III complications had associated vital sign abnormalities.
Routine overnight vital signs were associated with a low frequency of clinically significant events. Reduced intensity of overnight vital sign checks may be a safe addition to enhanced-recovery packages in carefully selected patients.
有证据表明，患者睡眠中断与不良临床结局相关。夜间生命体征检查是导致患者睡眠中断的常见原因。我们旨在确定在接受膀胱癌根治性膀胱切除术的稳定术后患者中，常规夜间生命体征检查的实用性。
我们建立了一个数据库，其中包含了在我们机构进行根治性膀胱切除术的所有患者在术后第 0 天至第 6 天的所有常规生命体征检查结果。根据特定标准将夜间生命体征设置标记为“异常”，然后由 2 名盲审员进行审查，以确定它们是否与显著的临床干预相关。
共有 546 名患者代表了医院内的 2589 个患者夜，其中 17/2589（0.65%）个患者夜的异常生命体征导致了“中度”或“重度”临床干预（对应于 Clavien-Dindo 分级≥II 并发症的关注）。因此，需要 152 个患者夜的常规生命体征检查才能识别出一个中度或重度的临床事件。审查所有夜间发作的并发症，我们注意到大多数（15/23，65%）Clavien-Dindo 分级 II 并发症仅表现为症状或实验室异常，而没有生命体征改变，而所有≥III 级并发症都有相关的生命体征异常。
常规夜间生命体征与临床意义重大的事件发生频率较低相关。在经过仔细选择的患者中，减少夜间生命体征检查的强度可能是增强恢复方案的一个安全补充。
