Can metrics derived from smartphone accelerometer data capture differences in physical recovery among patients after surgery?
In this cohort study, smartphone accelerometer data captured decreases in daily exertional activity in patients with a postoperative event (eg, complication, reoperation) compared with baseline at up to 6 weeks after surgery. Similarly, these data demonstrated that fewer of these patients achieved at least 60 minutes of daily exertional activity in the first 6 weeks after surgery compared with patients without a postoperative event.
Physical activity measured passively through smartphone accelerometer data can be used to quantify differential recovery trends after surgery.
Patient-generated health data captured from smartphone sensors have the potential to better quantify the physical outcomes of surgery. The ability of these data to discriminate between postoperative trends in physical activity remains unknown.
To assess whether physical activity captured from smartphone accelerometer data can be used to describe postoperative recovery among patients undergoing cancer operations.
Design, Setting, and Participants
This prospective observational cohort study was conducted from July 2017 to April 2019 in a single academic tertiary care hospital in the United States. Preoperatively, adults (age ≥18 years) who spoke English and were undergoing elective operations for skin, soft tissue, head, neck, and abdominal cancers were approached. Patients were excluded if they did not own a smartphone.
Study participants downloaded an application that collected smartphone accelerometer data continuously for 1 week preoperatively and 6 months postoperatively.
Main Outcomes and Measures
The primary end points were trends in daily exertional activity and the ability to achieve at least 60 minutes of daily exertional activity after surgery among patients with vs without a clinically significant postoperative event. Postoperative events were defined as complications, emergency department presentations, readmissions, reoperations, and mortality.
A total of 139 individuals were approached. In the 62 enrolled patients, who were followed up for a median (interquartile range [IQR]) of 147 (77-179) days, there were no preprocedural differences between patients with vs without a postoperative event. Seventeen patients (27%) experienced a postoperative event. These patients had longer operations than those without a postoperative event (median [IQR], 225 [152-402] minutes vs 107 [68-174] minutes; P < .001), as well as greater blood loss (median [IQR], 200 [35-515] mL vs 25 [5-100] mL; P = .006) and more follow-up visits (median [IQR], 2 [2-4] visits vs 1 [1-2] visits; P = .002). Compared with mean baseline daily exertional activity, patients with a postoperative event had lower activity at week 1 (difference, −41.6 [95% CI, −75.1 to −8.0] minutes; P = .02), week 3 (difference, −40.0 [95% CI, −72.3 to −3.6] minutes; P = .03), week 5 (difference, −39.6 [95% CI, −69.1 to −10.1] minutes; P = .01), and week 6 (difference, −36.2 [95% CI, −64.5 to −7.8] minutes; P = .01) postoperatively. Fewer of these patients were able to achieve 60 minutes of daily exertional activity in the 6 weeks postoperatively (proportions: week 1, 0.40 [95% CI, 0.31-0.49]; P < .001; week 2, 0.49 [95% CI, 0.40-0.58]; P = .003; week 3, 0.39 [95% CI, 0.30-0.48]; P < .001; week 4, 0.47 [95% CI, 0.38-0.57]; P < .001; week 5, 0.51 [95% CI, 0.42-0.60]; P < .001; week 6, 0.73 [95% CI, 0.68-0.79] vs 0.43 [95% CI, 0.33-0.52]; P < .001).
Conclusions and Relevance
Smartphone accelerometer data can describe differences in postoperative physical activity among patients with vs without a postoperative event. These data help objectively quantify patient-centered surgical recovery, which have the potential to improve and promote shared decision-making, recovery monitoring, and patient engagement.
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Panda N, Solsky I, Huang EJ, et al. Using Smartphones to Capture Novel Recovery Metrics After Cancer Surgery. JAMA Surg. Published online October 28, 2019. doi:10.1001/jamasurg.2019.4702
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