Daily Step Count Is Associated with Frailty Status in Veterans Presenting for Major Operations

Area of Science:

• Gerontology
• Surgical Outcomes
• Physical Activity Measurement

Background:

• Frailty is an under-recognized predictor of poor surgical outcomes.
• Assessing preoperative functional status, like ambulation, is crucial for patient-centered care.
• Recovery of daily step counts one month post-surgery is a key outcome for older adults.

Purpose of the Study:

• To identify a preoperative daily step count threshold indicative of frailty.
• To compare one-month ambulation recovery in older surgical patients with and without frailty.
• To characterize the relationship between preoperative frailty and postoperative mobility.

Main Methods:

• Observational pilot study of older adults (≥60 years) undergoing elective inpatient surgery.
• Frailty assessed preoperatively; daily steps measured using accelerometers for at least 3 days pre- and 28 days post-surgery.
• Sensitivity analysis determined the step count threshold associated with frailty.

Main Results:

• 37.6% of participants were prefrail or frail, with lower preoperative steps/day (3322) compared to non-frail.
• A threshold of 4137 steps/day was significantly associated with preoperative frailty.
• No significant difference in percentage of daily steps recovered at 28 days between frail and non-frail groups.

Conclusions:

• Preoperative daily step counts below 4137 identify older veterans at higher risk of frailty before major surgery.
• Low median daily step counts (<5000) suggest sedentary lifestyles, potentially masking differences in recovery.
• Interventions to increase walking activity in older veterans awaiting surgery are warranted.