Digital Tracking of Patients Undergoing Radical Cystectomy for Bladder Cancer: Daily Step Counts Before and After Surgery Within the iROC Randomised Controlled Trial

Pramit Khetrapal; Parasdeep S Bains; Ibrahim Jubber; Gareth Ambler; Norman R Williams; Chris Brew-Graves; Ashwin Sridhar; Anthony Ta; John D Kelly; James W F Catto; iROC Study Team

doi:10.1016/j.euo.2023.09.021

Digital Tracking of Patients Undergoing Radical Cystectomy for Bladder Cancer: Daily Step Counts Before and After Surgery Within the iROC Randomised Controlled Trial

Eur Urol Oncol. 2023 Oct 16:S2588-9311(23)00213-4. doi: 10.1016/j.euo.2023.09.021. Online ahead of print.

Authors

Affiliations

¹ Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK.
² Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK.
³ Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
⁴ Department of Statistical Science, University College London, London, UK.
⁵ Surgical & Interventional Trials Unit (SITU), Division of Surgery & Interventional Science, University College London, London, UK.
⁶ UCL Centre for Medical Imaging, Division of Medicine, University College London, London, UK.
⁷ Department of Urology, University College London Hospital, London, UK.
⁸ Division of Surgery & Interventional Science, University College London, London, UK; Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. Electronic address: j.catto@sheffield.ac.uk.

PMID: 37852921
DOI: 10.1016/j.euo.2023.09.021

Abstract

Background: Efforts to improve recovery after radical cystectomy (RC) are needed.

Objective: To investigate wrist-worn wearable activity trackers in RC participants.

Design, setting, and participants: An observational cohort study was conducted within the iROC randomised trial.

Intervention: Patients undergoing RC at nine cancer centres wore wrist-based trackers for 7 days (d) at intervals before and after surgery.

Outcome measurements and statistical analysis: Step counts were compared with participant and operative features, and recovery outcomes.

Results and limitations: Of 308 participants, 284 (92.2%) returned digital activity data at baseline (median 17 d [interquartile range: 8-32] before RC), and postoperatively (5 [5-6] d) and at weeks 5 (43 [38-43] d), 12 (94 [87-106] d), and 26 (192 [181-205] d) after RC. Compliance was affected by the time from surgery and a coronavirus disease 2019 pandemic lockdown (return rates fell to 0-7%, chi-square p < 0.001). Step counts dropped after surgery (mean of 28% of baseline), before recovering at 5 weeks (wk) (71% of baseline) and 12 wk (95% of baseline; all analysis of variance [ANOVA] p < 0.001). Baseline step counts were not associated with postoperative recovery or death. Patients with extended hospital stays had reduced postoperative step counts, with a difference of 2.2 d (95% confidence interval: 0.856-3.482 d) between the lowest third and highest two-third tertiles (linear regression analysis; p < 0.001). Additionally, they spent less time out of the hospital within 90 d of RC (80.3 vs 74.3 d, p = 0.013). Lower step counts at 5, 12, and 26 wk were seen in those seeking medical help and needing readmission (ANOVA p ≤ 0.002).

Conclusions: Baseline step counts were not associated with recovery. Lower postoperative step counts were associated with longer length of stay at the hospital and postdischarge readmissions. Studies are required to determine whether low step counts can identify patients at a risk of developing complications.

Patient summary: Postoperative step counts appear to be a promising tool to identify patients in the community needing medical help or readmission. More work is needed to understand which measures are most useful and how best to collect these.

Keywords: Aftercare; Cystectomy; Length of stay; Patient discharge; Patient readmission; Postoperative complications; Robotics; Wearable electronic devices.