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Wearable Activity Monitors Measuring Ambulation and Postop LOS Prediction
Study Questions:
What is the distribution of digitally monitored step count measured by wearable activity monitors among hospitalized patients after major elective surgery, and do these data improve mobility assessment and therefore help identify patients who are at risk for prolonged hospital length of stay (LOS) with greater accuracy, compared to standard assessment?
Methods:
A cohort of 100 patients undergoing one of eight specific elective inpatient surgical procedures were recruited and participated in this prospective trial, wearing wrist band activity monitors that passively measured daily step count from surgery until discharge. Surgeons used one of four standard options available in the electronic formulary to order activity level (bed rest, out-of-bed to chair, ambulate with assistance, and ambulate ad libitum), and were then asked to estimate the patient’s activity level in an ordinal fashion (none, out-of-bed to chair, once/twice/three times daily, and ad libitum) without access to step-count data. Prolonged LOS was defined as >70th percentile for each surgical procedure.
Results:
In the overall population, step count increased with each successive postoperative day, although there was significant variability observed between subjects, especially on earlier days. Logistic regression modeling, adjusted for age and comorbidity, and stratified by surgical procedure, indicated that every additional increment of 100 steps taken on postoperative day 1 was correlated with a 3.7% reduced risk of prolonged LOS, with a plateau observed above 1,000 steps. Although 95% of subjects’ orders requested ambulation with assistance, actual step count on day 1 ranged from 0 to 7,698. Surgeons’ estimates of their patients’ activity levels showed fair correlation with step count, but in numerous instances, patients who were assessed as having been out of bed and ambulating in fact registered zero steps on the activity monitor.
Conclusions:
Lack of ambulation, indicated by low step count from wristband activity monitor on postoperative day 1, identified patients with higher risk of prolonged LOS. Activity monitors collect scalable data, with potential to facilitate more accurate, specific, and appropriate directives and assessments.
Perspective:
These findings suggest a dose-dependent relationship between early postoperative ambulation and more timely achievement of recovery milestones. The extent to which ambulation itself produces more rapid recovery, or serves as indicator of overall fitness, deserves further study. The marked variability observed in estimated versus achieved mobility underscores the challenges facing physicians and caregivers in managing this important aspect of recovery using conventional, nonscaled measures. The quantitative nature of step count could encourage more specific goal setting, with potential to increase patient motivation, improve caregiver engagement, and allow earlier identification of patients who may benefit from proactive mobilization efforts, or in-depth evaluation for a variety of conditions that may contribute to delayed recovery.
Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Exercise
Keywords: Ambulatory Surgical Procedures, Comorbidity, Early Ambulation, Inpatients, Length of Stay, Monitoring, Ambulatory, Primary Prevention, Elective Surgical Procedures, Walking
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