90: Assessing activity and recovery following benign gynecologic surgery using an activity monitor and validated tool sets: A pilot study

Abstract

Assessment of recovery after surgery in women following benign gynecologic surgery remains highly subjective and elusive, as the majority of patient recovery is taking place at home and outside of the hospital. 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) feasibility of the use of an activity monitor in a gynecologic surgical patient population, 2) use activity monitor data to characterize the recovery trajectory of physical activity for laparoscopic and open surgeries. Women aged 18-51 years old undergoing elective inpatient and outpatient surgical procedures at an academic tertiary medical center, specifically myomectomy and hysterectomy, were invited to participate. Physical activity was measured using an Actigraph GT3X wrist worn activity monitor. Participants wore the activity monitor a week before the surgery to assess preoperative baseline activity and they were asked to wear them for a minimum 6 weeks postop. The total number of steps was measured for each patient per day, and the time (in days) to baseline recovery activity was measured. Of the 15 patients enrolled, 13 patients completed the study procedures and were included in the analysis. 9 underwent a laparoscopic or robot-assisted laparoscopic procedure; 4 underwent a laparotomy. Of the 9 minimally invasive procedures, 7 were hysterectomies and 2 were myomectomies. Of the laparotomies, 2 were hysterectomies and 2 were myomectomies. The mean number of days the activity monitor was worn was 45 days (SD 27) for all procedures. For minimally invasive outpatient procedures, the total number of steps per day reached preoperative average levels on postoperative day (POD) 7.8 (SD 7.5). For laparotomies that required inpatient stay, the total number of steps per day reached preoperative average levels on POD 33.5 (SD 24.5). An adverse event in 1 patient was associated with a decline in activity. This study demonstrates that objective monitoring of postoperative physical activity using activity monitors is feasible in the benign gynecologic surgical population. Recovery trajectories for inpatient laparotomies and outpatient minimally invasive procedures differ. Activity monitors present clinicians with a new potential tool for assessing and managing surgical recovery, and for determining if women are not recovering as expected.