Feasibility of wearable activity trackers in cystectomy patients to monitor for postoperative complications

Abstract

Background: To determine the feasibility of using wearables in patients undergoing radical cystectomy to monitor postoperative heart rate and activity and attempt to correlate these factors to complications and readmissions. Materials and methods: We conducted a prospective study of 20 patients undergoing radical cystectomy for bladder cancer between June 2017 and March 2018. Each patient was provided with a Garmin Vívofit heart rate (HR) activity tracker and instructed to wear it on their wrist for 30 days postoperatively. Heart rate, steps, and sleep data were collected during this time. Patients were called at 10-day intervals and surveyed for complications and device compliance. Univariable mixed effects logistic regression models were used to compare daily activity tracker measures with occurrence of an adverse event. Odds ratios, 95% confidence intervals, and p -values were reported. Results: Median age was 65 (interquartile range 61–74) years. Patients had usable data for a median of 59.3% (interquartile range 25–71.7%) of the time. Five patients experienced a postoperative event (1 readmission for sepsis from urinary tract source, 1 inpatient rapid response called for tachycardic event, 3 unscheduled visits related to dehydration), where event data was recorded over a total of 17 days. Higher step count was associated with reduced odds of an adverse event (odds ratio 0.31, 95% confidence interval 0.10–0.98 per 1000 steps, p = 0.047). Conclusions: Postoperative activity and heart rate monitoring in cystectomy patients is feasible though current wearables are not well suited for this task.

Editorial Comment

“…A study by Slade et al published last year using a similar approach, albeit with telephone rather than app-based surveys, found associations between higher step counts (activity) and a lower risk of postoperative complication following cystectomy. 1 In the colorectal literature, similar findings were noted regarding 30-day readmission when assessed in the first postoperative days after surgery, prior to discharge, and relative to baseline activity status. 2 Interestingly, another study utilizing machine learning with preoperative activity levels and patient characteristics outperformed the American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator in predicting outcomes of pancreatectomy.…”

Digital health innovations in urology: telemedicine, wearables, and mobile applications – a systematic review of literature

“…Technical issues such as connectivity problems and software bugs can impede the administration of care [22]. A significant portion of the available data on wearable medical devices comes from experimental studies or limited patient trials [34]. This limited pool of data makes it difficult to evaluate various performance issues, such as motion errors and sensor placement-dependent accuracy of device functionality [26 ▪▪ ].…”

“…PAM successfully captured perioperative biophysical parameters and was correlated with high patient satisfaction. Slade et al [34] evaluated the viability of using wearable devices in patients undergoing radical cystectomy to monitor postoperative heart rate and activity. According to the results, monitoring postoperative activity and heart rate in cystectomy patients was feasible, despite the fact that current wearables are not ideally suitable for this task.…”

The Use of Wearable Devices in Oncology Patients: A Systematic Review

“… 147 In addition, wearable devices capture physical activity data in continuous, real-time, free-living settings without interrupting participants’ day-to-day. 11 , 17 , 18 , 21-23 , 25 , 40 , 44 , 45 , 51 , 62 , 63 , 66 , 76 , 83 , 85 , 86 , 89 , 90 , 92 , 104 , 108 , 111 , 112 , 119 , 122 , 126 , 128 , 129 , 136 , 139 , 142 , 143 , 147 , 157 , 158 , 161 , 163 , 166 , 172 , 173 , 176-178 , 181 , 188 , 192 , 194 , 208 Of the studies that reported on the adherence of wearable devices, 43 (70%) of them cited high adherence at greater than 80%. Additionally, feasibility studies generally noted positive experience/satisfaction using wearable devices, citing ease of use, comfort, usefulness, and no interference with daily activity related to Fitbits, ActivPal, and Biovotion AG devices.…”