J. B. Pitt1, S. Zeineddin1, M. Carter1, S. Kwon1, A. Figueroa1, M. DeTella1, E. Park1, A. Perez1, H. Ghomrawi1, F. Abdullah1 1Ann & Robert H. Lurie Children’s Hospital of Chicago, Division Of Pediatric Surgery, Chicago, IL, USA
Introduction:
Markers of surgical recovery in pediatric patients undergoing surgery are difficult to gauge by parents post-discharge, who use subjective proxies to assess recovery and the onset of complications. Consumer wearable devices (e.g., Fitbit) generate objective data and provide an opportunity to monitor postoperative patients and identify complications beyond the initial hospitalization. The aim of this study was to use daily step counts from a Fitbit to detect postoperative surgical complications in patients with complicated appendicitis.
Methods:
After obtaining IRB approval, children ages 3-17 years old undergoing laparoscopic appendectomy for complicated appendicitis were recruited. Patients wore the Fitbit Inspire HR or Fitbit Inspire 2 for 21 days after operation, during which data was collected for patients with diagnosis of complicated appendicitis. After collection, patient data was included if a minimum wear time criteria was achieved defined as minute-by-minute heart rate data available for at least 600 minutes during normal waking hours. Postoperative complications were identified through chart review and recovery trajectories for normal recovery and complications were generated. For patients with complication, the day of presentation with complication was normalized and average daily step count for pre and post-complication were analyzed.
Results:
Eighty six patients with complicated appendicitis were enrolled in the study, and fourteen children developed a post-operative complication. Three of these patients were excluded because they did not meet the minimum wear time requirements. Complications were divided into three categories: abscess (n=7, 64%), surgical site infection (n=2, 18%) and other, which included small bowel obstruction and Clostridium difficile infection (n=2, 18%). Patients presented with complication on mean postoperative day 8 (IQR 6-9). When compared to children with normal recovery, the patients with surgical complications experienced a slower increase in step count. When corrected for day of presentation with complication, step count remained below 3000 steps/day and rejoined similar trajectory to normal recovery after treatment.
Conclusion:
Post-operative complications can be identified using step count from wearable devices. This study has identified a variation from the normal recovery trajectory in patients with complication after appendectomy for complicated appendicitis with distinct trajectory patterns for complication type. This offers clinical implications for monitoring pediatric patients postoperatively providing an objective measure to monitor their recovery outside of the hospital with the potential for earlier identification of complications than the current system.
