• Ramin Fallahzadeh, Franck Verdonk, Ed Ganio, Anthony Culos, Natalie Stanley, Ivana Maric, Alan L Chang, Martin Becker, Thanaphong Phongpreecha, Maria Xenochristou, Davide De Francesco, Camilo Espinosa, Xiaoxiao Gao, Amy Tsai, Pervez Sultan, Martha Tingle, Derek F Amanatullah, James I Huddleston, Stuart B Goodman, Brice Gaudilliere, Martin S Angst, and Nima Aghaeepour.
• Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford CA.
• Ann. Surg. 2023 Mar 1; 277 (3): e503e512e503-e512.

ObjectiveThe longitudinal assessment of physical function with high temporal resolution at a scalable and objective level in patients recovering from surgery is highly desirable to understand the biological and clinical factors that drive the clinical outcome. However, physical recovery from surgery itself remains poorly defined and the utility of wearable technologies to study recovery after surgery has not been established.BackgroundProlonged postoperative recovery is often associated with long-lasting impairment of physical, mental, and social functions. Although phenotypical and clinical patient characteristics account for some variation of individual recovery trajectories, biological differences likely play a major role. Specifically, patient-specific immune states have been linked to prolonged physical impairment after surgery. However, current methods of quantifying physical recovery lack patient specificity and objectivity.MethodsHere, a combined high-fidelity accelerometry and state-of-the-art deep immune profiling approach was studied in patients undergoing major joint replacement surgery. The aim was to determine whether objective physical parameters derived from accelerometry data can accurately track patient-specific physical recovery profiles (suggestive of a 'clock of postoperative recovery'), compare the performance of derived parameters with benchmark metrics including step count, and link individual recovery profiles with patients' preoperative immune state.ResultsThe results of our models indicate that patient-specific temporal patterns of physical function can be derived with a precision superior to benchmark metrics. Notably, 6 distinct domains of physical function and sleep are identified to represent the objective temporal patterns: ''activity capacity'' and ''moderate and overall activity (declined immediately after surgery); ''sleep disruption and sedentary activity (increased after surgery); ''overall sleep'', ''sleep onset'', and ''light activity'' (no clear changes were observed after surgery). These patterns can be linked to individual patients preopera-tive immune state using cross-validated canonical-correlation analysis. Importantly, the pSTAT3 signal activity in monocytic myeloid-derived suppressor cells predicted a slower recovery.ConclusionsAccelerometry-based recovery trajectories are scalable and objective outcomes to study patient-specific factors that drive physical recovery.Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.

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