Wearables in urology
Wearable devices have the potential to change the landscape of preoperative optimization as well as postoperative monitoring of high-risk patients or patients undergoing high-risk surgeries. For example, cystectomy has 90-day readmission rates as high as 40%. The ability to identify patients at risk for or in the early stages of serious postoperative complications, such as sepsis, would not only improve outcomes but also save millions in health care dollars. As an added bonus, reliable at-home monitoring would also potentially allow for early discharge and increased willingness of patients to discharge early.
A 2017 survey examining urology patient perspectives on wearing physical activity monitors was sent to all patients treated at Mayo Clinic in Rochester, MN during a 6-month period. The survey had 1,043 responders (19%), 20% of whom reported already using a wearable activity monitor and 82% of whom would be willing to use one for their medical care (Urol Pract 2017; 4:508-14). Though this study is limited by its single-institution nature, limited survey response, and response bias, these findings suggest a high level of patient acceptance for involving wearable technology into care.
Several studies using wearables in the urologic surgery setting are either underway or recently completed (table).
In 2016, Mayo Clinic Rochester performed a feasibility study on 42 patients undergoing radical prostatectomy. The participants were provided with a Fitbit Charge HR for 3-4 days preoperatively and wore the device for 1 week. While the wearables were well received by patients, only 69% had retrievable data. Of those who had retrievable data, overall device compliance varied from 75% to 95% (J Endourol 2016; 30[S2], abs. MP6-14). The study highlights the challenges surrounding the use of wearables currently on the market, which require heavy user dependency for charging and wearing the device as well as maintaining a Bluetooth phone connection for data syncing.
A team at the University of Kansas utilized activity monitors as part of a preoperative optimization plan for overweight patients prior to prostatectomy. Though wearing the activity monitor was only one part of a series of interventions that included behavior coaching, diet, and physical activity, the 15 patients in the intervention arm experienced an average 6 kg of weight loss, 11 mg/dL reduction in fasting glucose, 8 mm Hg reduction in systolic blood pressure, and a reduction in the leptin to adiponectin ratio. Weight loss was maintained at 12 weeks post-prostatectomy, and physical quality of life was noted to be better in the intervention group (J Urol 2017; 197:e1242, abs. MP93-15).
A 2018 abstract from the United Kingdom tested the feasibility of wearing fitness trackers on patients undergoing radical cystectomy for bladder cancer. A component of this study was to correlate number of steps, as a surrogate for patient activity, with the 30-second sit-to-stand test and EQ-5DL-5L standardized health and mobility questionnaire. Of the 30 patients initially included in the study, 26 complied with wearing the device. The 7-day median daily post-cystectomy step count was 5,498 and did not correlate with the sit-to-stand test or EQ-5DL-5L (J Urol 2018; 199:e950, abs. MP71-18).
While this study is still in an early phase, it demonstrates the feasibility of activity monitoring in cystectomy patients as well as the uniqueness of activity data. Given the lack of correlation with validated mobility measures, the question remains whether this device is adequately sensitive to capture postoperative movement or is measuring a unique movement domain altogether.
A similar study from the University of Southern California used wearables to track patient steps, daily calories burned, and sleep characteristics before hospitalization, during hospitalization, and after cystectomy. The authors found patients on average recorded 4,806 daily steps preoperatively, and in contrast with the UK study, only averaged 1,517 steps per day postoperatively. Average sleep was found to be 5.3 hours per day preoperatively and 4.9 hours postoperatively (J Urol 2018; 199:e336, abs. MP26-04). The introduction of sleep monitoring adds another variable to potential remote postoperative monitoring via wearable devices, although its clinical implications remain unknown.
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