Usefulness of measuring temporal changes in physical activity levels using an accelerometer for prediction and early detection of postoperative complications after hepatectomy

Iida, Hiroya; Maehira, Hiromitsu; Mori, Haruki; Takebayashi, Katsushi; Kojima, Masatsugu; Ueki, Tomoyuki; Kaida, Sachiko; Miyake, Toru; Tomida, Kaori; Shimizu, Tomoharu; Tani, Masaji

doi:10.1016/j.hpb.2021.05.011

Cited by 6 publications

(25 citation statements)

References 41 publications

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“…Patients with a ‘steady increase’ had a low risk of complications. Wound infections, pleural effusions, and ascites were more common in the bell curve group, and postoperative pneumonia was observed only in patients with a flat recovery profile 79 . Robinson et al .…”

Section: Resultsmentioning

confidence: 90%

“…Iida et al . investigated the impact of different recovery trajectories following hepatectomy, classifying patients into ‘steady increase’, ‘bell curve’, and ‘flat’ categories 78 , 79 . Patients with a ‘steady increase’ had a low risk of complications.…”

Section: Resultsmentioning

confidence: 99%

“…Normalizing a patient’s postoperative physical activity relative to their baseline may be a more appropriate method for risk assessment 76 , 80 , and the characterization of mobilization ‘patterns’ as suggested by Iida et al . may offer more detailed insights into the prediction of specific postoperative complications 78 , 79 . The ability of physical activity to predict complications in ‘real time’, as opposed to retrospectively, also remains unclear, and requires further targeted investigation.…”

Section: Discussionmentioning

confidence: 99%

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Wearable devices to monitor recovery after abdominal surgery: scoping review

Wells

Penfold

et al. 2022

BJS Open

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Background Wearable devices have been proposed as a novel method for monitoring patients after surgery to track recovery, identify complications early, and improve surgical safety. Previous studies have used a heterogeneous range of devices, methods, and analyses. This review aimed to examine current methods and wearable devices used for monitoring after abdominal surgery and identify knowledge gaps requiring further investigation. Methods A scoping review was conducted given the heterogeneous nature of the evidence. MEDLINE, EMBASE, and Scopus databases were systematically searched. Studies of wearable devices for monitoring of adult patients within 30 days after abdominal surgery were eligible for inclusion. Results A total of 78 articles from 65 study cohorts, with 5153 patients were included. Thirty-one different wearable devices were used to measure vital signs, physiological measurements, or physical activity. The duration of postoperative wearable device use ranged from 15 h to 3 months after surgery. Studies mostly focused on physical activity metrics (71.8 per cent). Continuous vital sign measurement and physical activity tracking both showed promise for detecting postoperative complications earlier than usual care, but conclusions were limited by poor device precision, adherence, occurrence of false alarms, data transmission problems, and retrospective data analysis. Devices were generally well accepted by patients, with high levels of acceptance, comfort, and safety. Conclusion Wearable technology has not yet realized its potential to improve postoperative monitoring. Further work is needed to overcome technical limitations, improve precision, and reduce false alarms. Prospective assessment of efficacy, using an intention-to-treat approach should be the focus of further studies.

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Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Wearable devices to monitor recovery after abdominal surgery: scoping review

Wells

Penfold

et al. 2022

BJS Open

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“…All studies used accelerometers during the acute inpatient period (per our inclusion criteria). Of the 15 studies, 12 (80%) applied the device within a day after surgery (n=7, 58%, studies on the day of surgery [ 30 - 32 , 35 , 36 , 38 , 39 ] and n=5, 42%, studies on postoperative day 1 or within 24 hours after surgery [ 27 , 29 , 33 , 37 , 40 ]). Of the 15 studies, 2 (13%) started the device wear after patients were transferred to the floor from the intensive care unit, which occurred on postoperative day 2 or 3 on average [ 28 , 41 ], and 1 (7%) did not report the timing of initiation [ 34 ].…”

Section: Resultsmentioning

confidence: 99%

Accelerometer-Measured Inpatient Physical Activity and Associated Outcomes After Major Abdominal Surgery: Systematic Review

Fuchita¹,

Ridgeway²,

Kimzey³

et al. 2023

Interact J Med Res

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Background It remains unclear how inpatient physical activity after major abdominal surgery affects outcomes. Accelerometer research may provide further evidence for postoperative mobilization. Objective We aimed to summarize the current literature evaluating the impact of accelerometer-measured postoperative physical activity on outcomes after major abdominal surgery. Methods We searched PubMed and Google Scholar in October 2021 to conduct a systematic review. Studies were included if they used accelerometers to measure inpatient physical behaviors immediately after major abdominal surgery, defined as any nonobstetric procedures performed under general anesthesia requiring hospital admission. Studies were eligible only if they evaluated the effects of physical activity on postoperative outcomes such as postoperative complications, return of gastrointestinal function, hospital length of stay, discharge destination, and readmissions. We excluded studies involving participants aged <18 years. Risk of bias was assessed using the risk-of-bias assessment tool for nonrandomized studies (RoBANS) for observational studies and the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for randomized controlled trials (RCTs). Findings were summarized by qualitative synthesis. Results We identified 15 studies. Risk of bias was high in 14 (93%) of the 15 studies. Most of the studies (11/15, 73%) had sample sizes of <100. Of the 15 studies, 13 (87%) included the general surgery population, 1 (7%) was a study of patients who had undergone gynecologic surgery, and 1 (7%) included a mixed (abdominal, thoracic, gynecologic, and orthopedic) surgical population. Of the 15 studies, 12 (80%) used consumer-grade accelerometers to measure physical behaviors. Step count was the most commonly reported physical activity outcome (12/15, 80%). In the observational studies (9/15, 60%), increased physical activity during the immediate postoperative period was associated with earlier return of gastrointestinal function, fewer surgical and pulmonary complications, shorter hospital length of stay, and fewer readmissions. In the RCTs (6/15, 40%), only 1 (17%) of the 6 studies demonstrated improved outcomes (shorter time to flatus and hospital length of stay) when a mobility-enhancing intervention was compared with usual care. Notably, mobility-enhancing interventions used in 4 (67%) of the 6 RCTs did not result in increased postoperative physical activity. Conclusions Although observational studies show strong associations between postoperative physical activity and outcomes after major abdominal surgery, RCTs have not proved the benefit of mobility-enhancing interventions compared with usual care. The overall risk of bias was high, and we could not synthesize specific recommendations for postoperative mobilization. Future research would benefit from improving study design, increasing methodologic rigor, and measuring physical behaviors beyond step counts to understand the impact of postoperative mobilization on outcomes after major abdominal surgery.

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“…Thus, we conducted a pilot study to determine the relationship between physical activity levels and post-hepatectomy complications [ 12 ]. Subsequently, a prospective study was performed to investigate the relationship between postoperative physical activity levels and the occurrence of post-hepatectomy complications [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Physical Activity Level Measurement by Accelerometer for Predicting Post-Hepatectomy Complications: A Prospective Observational Study

et al. 2022

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Introduction Recently, accelerometers have received much attention around the world. This study examined whether preoperative physical activity level measured by an accelerometer can be a useful predictor of post-hepatectomy complications. Methods Between December 2016 and December 2020, the physical activity levels of 185 patients were measured using an accelerometer 3 days before hepatectomy and from postoperative day 1 to 7. The patients without postoperative complications (n=153) and those with postoperative complications (n=32) were compared using either the chi-square test or Fisher’s exact test for nominal variables; continuous variables were analyzed using either Student’s t-test or Mann–Whitney U test. Differences were considered statistically significant when p-value was <0.05. Risk factors for postoperative complications following hepatectomy were also investigated. Results The number of patients with an anatomical resection was significantly higher in patients with postoperative complications (p=0.001). Furthermore, laparoscopic hepatectomy was performed in 65.4% of patients without postoperative complications and in 25.0% of those with postoperative complications; the difference was statistically significant (p<0.001). The average preoperative physical activity level was 150.6 kcal/day in patients without postoperative complications and 84.5 kcal/day in those with postoperative complications (p=0.001). Multivariate analysis identified blood loss, operative time, and preoperative physical activity level as independent risk factors for postoperative complications. Discussion/Conclusion Patients with lower preoperative physical activity levels are at a high risk of developing postoperative complications after hepatectomy. Hence, preoperative physical activity level measurement may be useful in predicting post-hepatectomy complications.

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Usefulness of measuring temporal changes in physical activity levels using an accelerometer for prediction and early detection of postoperative complications after hepatectomy

Cited by 6 publications

References 41 publications

Wearable devices to monitor recovery after abdominal surgery: scoping review

Wearable devices to monitor recovery after abdominal surgery: scoping review

Accelerometer-Measured Inpatient Physical Activity and Associated Outcomes After Major Abdominal Surgery: Systematic Review

Preoperative Physical Activity Level Measurement by Accelerometer for Predicting Post-Hepatectomy Complications: A Prospective Observational Study

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