Evaluation of Wearables for Preoperative Cardiorespiratory Fitness Screening and Risk Stratification in Geriatric Surgery

可穿戴设备在老年手术中进行术前心肺健康筛查和风险分层的评估

• 批准号: 10302751
• 负责人: Richard Boyer
• 金额: $ 16.95万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-15 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10302751
• 关键词: Activities of Daily Living; Address; Adult; Aerobic Exercise; Age; Aging; Agreement; Anesthesiology; Applications Grants; Behavioral Research; Cardiopulmonary; Caring; Chronic Disease; Clinical Research; Data; Decision Making; Development; Devices; Disease Management; Education; Elderly; Energy Metabolism; Enhancement Technology; Evaluation; Exercise; Exercise Test; Exercise Therapy; Foundations; Future; Geriatrics; Gold; Health Technology; Healthcare; Heart Rate; Human Resources; Indirect Calorimetry; Individual; Intervention; Knowledge; Logistics; Measurement; Measures; Medical; Memorial Sloan-Kettering Cancer Center; Modeling; Monitor; Morbidity - disease rate; Oncology; Operative Surgical Procedures; Outcome; Oxygen; Palliative Medicine; Patient-Focused Outcomes; Patients; Perioperative; Perioperative complication; Physiologic Monitoring; Physiological; Physiology; Pilot Projects; Population; Postoperative Complications; Postoperative Period; Predictive Value; Protocols documentation; Provider; Public Health; Quality of life; Recovery; Research; Risk; Risk Assessment; Schedule; Surgical complication; System; Testing; United States; Variant; Walking; Work; Workload; aged; aging and technology; base; cardiorespiratory fitness; clinical practice; comorbidity; cost effective; disability; equipment training; exercise intensity; exercise intervention; exercise program; experience; fitness; frailty; hemodynamics; high risk; human old age (65+); improved; medical schools; metabolic rate; mortality; multisensory; older patient; perioperative morbidity; perioperative mortality; predictive modeling; prospective; risk stratification; screening; sex; signal processing; surgery outcome; surgical risk; tool; trend; uptake; wearable device

PROJECT SUMMARY Major surgeries are becoming increasingly common in older adults with approximately half of the population over the age of 65 years requiring surgery at least once during the remainder of their lives. This trend is highly concerning for public health, because older adults are well known to suffer high rates of postoperative morbidity and mortality following major surgeries due to diminished functional capacity, comorbidities, frailty, and lack of access to comprehensive geriatric care. Preoperative risk stratification is of particular importance in geriatric surgery to identify patients at increased risk of surgical complications, to fully inform patients and providers in their surgical decision-making, and to determine if additional preoperative testing or medical interventions are required prior to surgery. Functional capacity as measured by maximum oxygen uptake (VO2peak), is an important factor in older adults presenting for major surgery, because it is highly correlated to postoperative morbidity and mortality, provides a holistic picture of cardiorespiratory fitness, and is modifiable with prehabilitation exercise programs. Although direct measurement of maximum oxygen uptake is possible with sophisticated cardiopulmonary exercise testing (CPET), wide-scale implementation of this measurement is not practical due to the need for specialized equipment, trained personnel, and financial and logistical challenges. Wearable fitness monitors capable of remote mobility and physiology monitoring offer an alternative to direct cardiopulmonary exercise measurement through indirect prediction of functional capacity using cardiorespiratory fitness metrics, such as exercise intensity and heart rate reserve. The proposed research aims to: (1) assess the accuracy of wearable devices for predicting VO2peak in older adults; and (2) evaluate the odds of perioperative complications using wearable-predicted VO2peak in older adults undergoing major noncardiac surgery. A prospective observational clinical study will be conducted to measure preoperative wearable fitness monitor data and gold-standard CPET-measured VO2peak in older adults scheduled for major surgery at Weill Cornell Medical College. This project will be the first to use wearable fitness monitors for preoperative cardiorespiratory fitness screening and risk stratification in older adults, and will set the stage for future studies of wearable protocols for surgical risk stratification in older adults and wearable-guided prehabilitation interventions. The contribution will be significant because it is expected to improve preoperative screening in vulnerable older adults scheduled for major surgery with practical, cost effective and accessible consumer health technology.

项目概要 大型手术在老年人中变得越来越普遍，约占人口的一半 65岁以上的人在其余生中至少需要进行一次手术。这种趋势非常 涉及公共健康，因为众所周知，老年人术后并发症发生率很高 由于功能能力下降、合并症、虚弱、大手术后的发病率和死亡率 以及缺乏全面的老年护理。术前风险分层尤其重要 老年手术，以确定手术并发症风险增加的患者，充分告知患者和 提供者进行手术决策，并确定是否需要额外的术前测试或医疗 手术前需要进行干预。通过最大摄氧量衡量的功能能力 （VO2peak）是老年人接受大手术的一个重要因素，因为它与 术后发病率和死亡率，提供心肺健康的整体情况，并且是可修改的 与预康复锻炼计划。尽管可以直接测量最大摄氧量 通过复杂的心肺运动测试（CPET），该测量的广泛实施是 由于需要专门设备、训练有素的人员以及财务和后勤，不切实际 挑战。能够远程移动和生理监测的可穿戴健身监视器提供了 通过间接预测功能能力来替代直接心肺运动测量 使用心肺健康指标，例如运动强度和心率储备。拟议的 研究目的是：（1）评估可穿戴设备预测老年人摄氧量峰值的准确性；和（2） 使用可穿戴设备预测的 VO2peak 评估接受手术的老年人围手术期并发症的几率 主要的非心脏手术。将进行一项前瞻性观察性临床研究来测量术前 可穿戴健身监测器数据和金标准 CPET 测量的老年人预定参加重大赛事的 VO2peak 威尔康奈尔医学院的手术。该项目将是第一个使用可穿戴健身监测器的项目 对老年人进行术前心肺健康筛查和风险分层，并将为 用于老年人手术风险分层的可穿戴协议的未来研究和可穿戴引导 预康复干预。这一贡献将是巨大的，因为预计会改善术前情况 对计划进行大手术的弱势老年人进行实用、具有成本效益且易于获得的筛查 消费者健康技术。