IEEE Systems, Man and Cybernetics Magazine - July 2020 - 40

SHUTTERSTOCK

related to liver, kidney, and heart function; glucose;
lactate; ions; and various biomarkers in biofluids. In
addition, pathogens and viruses may need to be detected. Different health conditions are characterized by
combinations of physiological parameters, many of
which are not specific to a particular disorder. Thus, a
wide range of parameters must be considered to obtain
a holistic understanding of a patient's health. This
approach is, of course, routinely practiced in hospitals,
using an array of techniques; however, it is only now
emerging in the field of wearables/implantables and
point-of-care devices [1], [2]. Continuous monitoring
can reveal patterns in the evolution of these parameters through time and as a function of various conditions that would otherwise be overlooked by typical
per iodic sa mpling. With a n aging population a nd
increased life expectancy, a lack of health-care systems, a nd limited resources in ma ny pa r ts of the
world, there is a need for patient-centric approaches
to medicine, not only to decentralize health-care systems but to ensure worldwide access to inexpensive
and reliable medical technologies.
Advances in fabrication techniques, electronics, and
sensors and in the consumer-electronics industry, the
rise of the Internet of Things, and the widespread availability of smart, portable devices have led to the development of a wide range of wearables for physiological
measurement [3]. Nevertheless, the devices' capabilities
are limited, and their use is mainly intended for consumer fitness/wellness monitoring, with unreliable or limited
data for medical diagnostics. Physiological monitoring

for athletes is attracting significant attention, with
efforts focusing on sweat analysis [4]. New advances in
sensing are driving breakthroughs in implantable devices
with diagnostic and therapeutic capabilities. Developments such as the pacemaker and, more recently, deep
brain stimulation and cochlear implants, have paved the
way for the next generation of miniaturized wireless
implants. The application of such technologies throughout the perioperative-care pathway (Figure 1) presents an
interesting case for their use for different embodiment
requirements and challenges.

Sensing Across the Surgical-Care Pathway
To develop impactful solutions, it is important to comprehend the surgical-care pathway, including the pre-, periand postoperative phases (Figure 1), and assess the
relevant clinical gaps and hurdles associated with each.
Different technologies and devices may be used to improve
value across the entire surgical pathway [5]. During the
preoperative phase, lifestyle factors are directly linked to
the outcome of major surgical procedures and postoperative complications. Currently, the needs of high-risk
patients (~15% of U.K. patients who need surgery; that is,
250,000) are unmet, with four out of five deaths after surgery occurring within this group [6]. Changes in physiology, heralding the exacerbation of chronic conditions, may
not be detected through current "snapshot" preoperative
assessments and optimized adequately; hence, they may
manifest postoperatively, leading to morbidity or protracted hospital stays. Similarly, for cancer patients receiving
therapies prior to surgery (neoadjuvant), the episodic macroscopic and structural imaging of tumors
makes it challenging to determine the best
time to surgically intervene. During the
perioperative phase, there is a need for
ECG and Pulse Oximetry
advanced in situ, real-time tissue-analysis
Patient Behavioral
Monitoring
tools to aid surgeons.
Rehabilitation
Medical Imaging
Postoperatively, complications, such
Monitoring
Bioimpedance
as
SSIs, catheter-related sepsis, wound
SSI
Point-of-Care
Biofluid Analysis
Monitoring
dehiscence, and colorectal anastomotic
Preoperative Phase
leakage (CAL) [7] may manifest. CAL
Respiration
occurs be--cause of anastomotic failure
Tissue
and is a leading cause of death following
Characterization
Biochemical
colorectal surgery. Complications in vasMonitoring
cular anastomosis (vein and artery) can
NIRS
develop with free-tissue transfer (FTT)
Postoperative Phase
Raman
following cancer removal or trauma.
Spectroscopy
These complications can be mild, necessiPerioperative Phase
Mass
tating oral antibiotic therapy and close
Spectrometry
observation in hospital, or serious, with
life-threatening sepsis that requires
Figure 1. The perioperative-care pathway and examples of sensors
repeated surgical and radiological interthat can address different requirements. Red: applicable across
ventions. Early detection is critical to
the perioperative-care pathway. Green: applicable during pre- and
postoperative phases. Yellow: applicable during peri- and postoperative ensure the prompt instigation of therapy.
phases. SSI: surgical-site infection; ECG: electrocardiography; NIRS: near- Yet, these complications tend to be
infrared spectroscopy.
detected far too late; for instance, CAL
40	

IEEE SYSTEMS, MAN, & CYBERNETICS MAGAZINE Ju ly 2020



IEEE Systems, Man and Cybernetics Magazine - July 2020

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