Digitally tracking daily postoperative steps could help gauge patient length of stay

The Cedars-Sinai study used Fitbit Charge trackers to monitor 100 patients following a major inpatient surgical procedure.
By Dave Muoio
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A study recently published in JAMA Network Open that employs Fitbit activity trackers found additional recorded steps were directly correlated to shorter hospital stays following an inpatient surgical procedure. Conducted at Cedars-Sinai, the investigation also attributed the monitors with improved accuracy when assessing a patient’s daily step count.

“We’re operationalizing this pop culture tech device for a real clinical purpose in the hospital, and using rigorous science to guide the process,” Dr. Timothy Daskivich, director of health services research for the Cedars-Sinai Department of Surgery and the study’s lead author, said in a statement. “We think it’s exciting and patients are responding to it.”

Topline data

Among 100 patients, ambulatory step count gradually increased with each day past surgery. However, patients who recorded a higher step count with their Fitbits on the first day after surgery were associated with a lower chance of prolonged length of stay — in fact, the researchers found that every 100 steps translated to a 3.7 percent reduction in that risk. No such risk reduction was identified after 1,000 steps, and while a similar analysis of postoperative day 2 step counts suggested a similar effect the trend was not statistically significant.

The researchers also noted that, while physician estimates of a patient’s daily ambulation generally tracked with average step count, there was a substantial variability in the number of actual steps taken by the patient. Given the data showing that length of stay outcomes could be influenced by as few as 100 daily steps, Daskivich and colleagues advocated for the use of digital trackers to offset estimate inaccuracies.

“That physicians are not more accurately measuring such a critical determinant of key outcomes seems outdated in the era of digital medicine,” they wrote.

How they did it

The researchers enrolled adult patients undergoing one of eight major inpatient operations between July 11, 2016 and August 30, 2017. Those who were admitted to an intensive care unit after surgery, were unable to walk due to physical limitation, or relied on a walker or wheelchair at baseline were excluded.

After the patient’s surgery, a researcher placed a Fitbit Charge on their wrist and encouraged the patient to keep it on throughout the hospitalization. The data from these monitors, surgeons’ estimates of patient step counts and other sociodemographic or relevant data was also collected for the analysis.

What’s the history

From clinical research projects to partnerships with Google and the NIH, there’s no shortage of health initiatives relying on Fitbit’s activity trackers. Some evidence suggests that patients may be more likely to adhere to the consumer-grade devices than they are medical-grade wearables, so it’s little surprise that Fitbit has devoted a substantial portion of its business to building out a device-driven connected health platform for providers, plans and employers alike.

In conclusion

“This study provides key implementation data and a rationale for integrating activity monitors into monitoring of postoperative ambulation after major surgery,” Daskivich and colleagues wrote. “We also show that the current standard of care for assessment and ordering of ambulation is inaccurate to a degree that may influence clinical outcomes. Activity monitors provide an inexpensive platform for more precise assessment, ordering, and monitoring of step count toward evidence-based daily goals and may indeed become a sixth vital sign for surgical teams.”