Abstract
BackgroundMultiple tools exist estimating perioperative risk. With an ageing surgical demographic, frailty is becoming an increasingly important concept in perioperative medicine due to its association with adverse post-operative outcomes. Reduced physical activity is a hallmark of frailty, and we postulate that a low pre-operative step count may be an objective measure of frailty. This study aimed to determine the association between low pre-operative step count and post-operative outcomes in patients undergoing elective colorectal cancer surgery.MethodsA prospective analysis of 85 older patients undergoing major elective colorectal surgery was performed at a tertiary centre between October 2017 and October 2018. Patients aged 65 years and over who met inclusion criteria were provided with an activity tracker to wear for 14 days prior to planned surgery. Their median daily step count was measured and a cut-off of < 2500 steps/day was used to define a reduced step count. Primary outcomes included length of stay and 30-day post-operative complication rate. Multivariable logistic regression analyses were used to analyze the influence of low pre-operative step count and other preoperative variables, on post-operative outcomes including mortality, prolonged hospital admission, and complication rates.ResultsOf 85 patients, 17 (20%) were identified as having a low pre-operative step count. A low pre-operative step count was associated with a significantly increased length of stay (14 vs. 6 days, IRR 2.09, 95% CI 1.55–2.83, p ≤ 0.01) and rate of major post-operative complications (29.4% vs. 8.8%, OR 3.34, 95% CI 1.03–14.3, p = 0.04). It was also associated with significantly increased rates of discharge to care facilities (p < 0.01) and requiring support on discharge (p = 0.03).ConclusionLow pre-operative step count (< 2500 steps/day) is predictive of an increased risk of post-operative morbidity in patients undergoing elective colorectal surgery. Accurate preoperative identification may allow for treatment modification and tailored perioperative care. The possibility of using a wearable activity tracker as a simple but powerful pre-habilitation tool is raised as an important avenue for future study.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12618000045213).
Highlights
The global population aged 65 years and older currently sits at approximately one billion with a steep upward trajectory predicted in this demographic (World Health Organization 2015)
Frailty is a concept that is becoming an integral component of perioperative risk assessment in older patients (Amrock and Deiner 2014; Beggs et al 2015); frailty has been independently associated with an increased risk of perioperative morbidity and mortality, prolonged hospital admissions, and discharge to care facilities (Fagard et al 2016; Lin et al 2016)
We propose that objectively quantifying preoperative physical activity may provide a novel and pragmatic marker of frailty and perioperative risk
Summary
The global population aged 65 years and older currently sits at approximately one billion with a steep upward trajectory predicted in this demographic (World Health Organization 2015). Frailty is a concept that is becoming an integral component of perioperative risk assessment in older patients (Amrock and Deiner 2014; Beggs et al 2015); frailty has been independently associated with an increased risk of perioperative morbidity and mortality, prolonged hospital admissions, and discharge to care facilities (Fagard et al 2016; Lin et al 2016). The frailty syndrome is a state of reduced physiologic reserve seen with increasing frequency with advancing age (Chen et al 2014). It is independent of any organ-specific diagnosis and has a significant functional component (Conroy and Elliott 2017). This study aimed to determine the association between low preoperative step count and post-operative outcomes in patients undergoing elective colorectal cancer surgery
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