The association between perioperative activity levels and discharge outcomes after radical cystectomy.

Abstract

Introduction: Early postoperative ambulation shortens the recovery of radical cystectomy (RC). This study aims to evaluate the potential associations between perioperative activity levels, measured by wearable fitness trackers (WFTs), and discharge outcomes after RC.

Methods: In this prospective study, patients undergoing RC between 2017 and 2019 wore WFTs from a maximum of 2 weeks preoperatively, throughout their hospitalization, and up to 2 weeks after discharge. Activity levels were recorded as daily steps and calorie expenditure. Primary outcomes of interest were discharge disposition to a nursing facility and prolonged length of stay (LOS ≥ 5 days).

Results: A total of 55 patients (80.0% male), with a median (IQR) age of 74 (65.0-79.5) years participated in the study, wearing the WFTs for a median of 18 (14.5-23) days. Twenty-seven (49%) patients had neobladders, and 11 (20.0%) were discharged to a nursing facility. The median LOS at the hospital was 4 (3.5-6) days. Patients with ileal conduit and those discharged to a nursing facility had significantly lower preoperative daily step counts compared to those who had neobladder and were discharged to home, respectively (both P < 0.05). Patients with prolonged LOS had lower daily calorie expenditure preoperatively (1,970 vs. 2,490, P < 0.001), and during hospitalization (1,850 vs. 2,070, P = 0.009).

Conclusion: Lower preoperative calorie expenditure and step counts are associated with prolonged LOS and higher rates of discharge to nursing facilities. Larger studies are required to determine whether lower baseline activity can affect clinical outcomes.