Ryan Macht, MD1, Amy Holmstrom, BA2, Kathryn Van Orden, MD1, Kevin Wong, BA2, Anthony Khalifeh, BA2, Brian Carmine, MD, FACS1, David McAneny, MD, FACS1, Donald Hess, MD, FACS1. 1Boston Medical Center, 2Boston University School of Medicine
Early postoperative mobilization is the standard of care for bariatric surgery. However, it is often challenging to motivate patients to walk following an operation. In addition, the inability to easily and accurately measure ambulation has made it difficult to evaluate the association between mobility and postoperative outcomes. Activity trackers have emerged commercially as an incentive for exercise, but they have rarely been utilized in the postoperative setting. The aims of this study are to evaluate activity trackers as a postoperative motivational tool and to assess the association between ambulation and bariatric surgery outcomes.
We performed a randomized trial at Boston Medical Center of all patients undergoing a primary bariatric operation. Patients were provided a Modus StepWatch activity tracker to wear immediately after their operation and until their two-week follow-up appointment. Patients underwent 1:1 randomization into two groups, with one group receiving no feedback on their step quantity and the other group receiving twice-daily ambulation feedback in the inpatient setting only. A brief survey was given to participants following the two-week study period.
Of 108 randomized patients, 87 had complete inpatient data, and 62 had both complete inpatient and outpatient data. No baseline differences in age, BMI, gender, or surgery type between the no-feedback and feedback groups were statistically significant (Table 1). No significant difference between groups was seen for inpatient steps/day (3,308 vs. 3,353, p=0.88) or outpatient steps/day (5,548 vs.5,842, p=0.59). When the two groups were combined, there was no significant association between steps/day and 6-week weight loss, hospital length of stay, or venous thromboembolism. However, those with a 30-day unplanned Emergency Department visit or hospital readmission had fewer initial inpatient steps/day (2,682 vs. 3,446, p=0.06) than those with no unplanned visit. Survey results demonstrated that 81% of patients agreed that wearing the activity tracker motivated them to walk more than if they were not wearing it.
The use of activity trackers in the postoperative setting is a promising intervention to motivate ambulation. Although, providing inpatient feedback did not significantly increase the amount of steps/day compared to wearing the tracker without feedback. Patients who ambulate less frequently in the initial postoperative period may be at higher risk for unplanned Emergency Department visits or readmissions. Early identification of these high-risk patients using activity trackers would allow for increased outpatient monitoring or additional interventions to prevent future unplanned visits.