Using accelerometers to characterize recovery after surgery in children.

BACKGROUND: Assessment of recovery after surgery in children remains highly subjective. However, advances in wearable technology present an opportunity for clinicians to have an objective assessment of postoperative recovery. The aims of this pilot study are to: (1) evaluate acceptability of accelerometer use in pediatric surgical patients, (2) use accelerometer data to characterize the recovery trajectory of physical activity, and (3) determine if postoperative adverse events are associated with a decrease in physical activity.

STUDY DESIGN: Children aged 3-18-years-old undergoing elective inpatient and outpatient surgical procedures were invited to participate. Physical activity was measured using an Actigraph GT3X wristworn accelerometer for ≥2days preoperatively and 5-14days postoperatively. Time spent performing light (LPA) and moderate-to-vigorous physical activity (MVPA) was expressed in minutes/day. Physical activity for each postoperative day was calculated as a percentage of preoperative activity, and recovery trajectories were produced. Adverse events were reported and mapped against recovery trajectories.

RESULTS: Of 60 patients enrolled, 25 (10 inpatients, 15 outpatients) completed the study procedures and were included in the analysis. For outpatient procedures, LPA recovered to preoperative level on postoperative day (POD) 7 and MVPA peaked at 90% on POD 8. For inpatient procedures, LPA peaked at 70% on POD 11, and MVPA peaked at 53% on POD 10. Adverse events in 2 patients were associated with a decline in activity.

CONCLUSIONS: This study demonstrates that objective monitoring of postoperative physical activity using accelerometers is feasible in the pediatric surgical population. Recovery trajectories for inpatient and outpatient procedures differ. Accelerometer technology presents clinicians with a new potential tool for assessing and managing surgical recovery, and for determining if children are not recovering as expected.

TYPE OF STUDY: Diagnostic Study.

LEVEL OF EVIDENCE: III.