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

Background/Objectives: Frailty is an under-recognized preoperative risk factor for poor surgical outcomes. Recovery of preoperative ambulation levels one month after surgery represents an important patient-centered outcome. The purpose of this study was to (1) identify a preoperative daily step count threshold associated with frailty, and (2) characterize the one-month ambulation recovery (steps/day) of older adults (≥60 years) with and without frailty following major elective inpatient operations. Methods: This single-center observational pilot study included older adults undergoing elective inpatient operations at a Veterans Affairs Hospital. Frailty was assessed before surgery. Ambulation (steps/day) was measured continuously from ≥3 full days before surgery, to at least 28 days after surgery, using a wrist-worn accelerometer. Sensitivity analysis identified a step count threshold associated with frailty. The primary outcome was the percentage of daily steps recovered at 28 days. Results: The average age of participants (n = 109) was 69 years, and 37.6% (41/109) were identified as prefrail or frail. Preoperative steps/day were lower in the frail cohort (3322.00 [2654.70, 5483.20] versus 4993.95 [3540.90, 6599.97], p < 0.05). Sensitivity analysis showed 4137 steps/day to be associated with preoperative frailty, and this remained significant in multivariate analysis. At 28 days, the percentage of daily steps recovered did not differ between groups (72.57% [49.15, 92.06] overall). Conclusions: Preoperative frailty is associated with lower daily step counts (<4137 steps/day), identifying individuals at increased likelihood of frailty in this older Veteran cohort undergoing major surgery. The median daily step count, regardless of frailty status, was <5000 steps/day, consistent with a sedentary lifestyle, and likely too low to show a difference in one-month ambulation recovery. This finding underscores the need to explore walking interventions in older Veterans awaiting surgery.