Grant Application

Jennifer Holder-Murray, MD, Katherine Moll Reitz, MD, David Medich, MD, James Celebrezze , MD, Javier Salgado , MD, and Andrew Watson, MD, UPMC Division of Colon and Rectal Surgery

Proposed Innovation

Enhanced recovery after surgery, or ERAS, is a set of protocols or care pathways used by the surgical team before, during, and after surgery to help ensure a patient has the best possible outcomes. Adopted by UPMC in 2015, these ERAS guidelines have resulted in rapid surgical recovery for colorectal surgery patients, reducing the length of stay from a median of 7 days to 4 days. Despite these improvements, there has been little emphasis on patients’ perioperative physical activity (PA) and its impact on functional recovery following surgery.

Through this project, wearable fitness devices will be used to track the activity of patients — before and after elective abdominal colorectal surgery — to determine how baseline PA impacts recovery and how monitoring can accelerate recovery.

Improvements in Action

In this pilot study, 23 activity monitors (ActiGraph GT9X) will be purchased. Considered the gold standard for PA monitoring in various clinical trials, these sophisticated trackers will be used to monitor the physical activity of 50 patients from 2 weeks before surgery through 6 weeks after surgery. Half of these patients will be given a tracker that displays a clock face while the other half will use trackers that display their daily steps in real time, which they will then record in a PA journal. In addition, all patients will complete a pre- and post-operative survey on their PA and functional status.

Results – In Progress

Data exported from the devices, including steps, heart rate, and calories expended, will be analyzed to determine the correlation between recorded and self-recorded PA levels. In addition, data will be used to compare the two groups to determine if maintaining a PA log with information displayed on the monitor results in increased pre- and postoperative activity and a faster return to baseline PA.

Use of the wearable fitness devices is expected to show that monitoring PA can have a positive effect on postoperative outcomes and functional recovery. The protocol can easily be adapted into the current ERAS program, with the potential for additional reductions in length of recovery and hospital stay.