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

项目摘要 大手术在老年人中越来越常见，约占人口的一半 65岁以上，在其余生中至少需要一次手术。这一趋势高度 关于公共卫生，因为众所周知，老年人术后并发症的发生率很高， 大手术后由于功能能力下降、合并症、虚弱 缺乏全面的老年护理。术前风险分层在以下情况下特别重要： 老年外科，以确定手术并发症风险增加的患者，充分告知患者， 提供者在他们的手术决策，并确定是否额外的术前测试或医疗 手术前需要进行干预。通过最大摄氧量测量的功能能力 （VO 2 peak）是老年人进行大手术的重要因素，因为它与以下因素高度相关： 术后发病率和死亡率，提供了心肺功能的整体情况，并且是可修改的 进行产前锻炼。虽然直接测量最大摄氧量是可能的 随着复杂的心肺运动测试（CPET），这种测量的大规模实施， 由于需要专门设备、训练有素的人员以及财务和后勤， 挑战可穿戴式健身监测器能够远程移动和生理监测， 通过间接预测功能能力替代直接心肺运动测量 使用心肺健康指标，如运动强度和心率储备。拟议 研究旨在：（1）评估可穿戴设备预测老年人VO 2峰值的准确性;以及（2） 使用可穿戴设备预测的VO 2 peak在接受手术的老年人中评估围手术期并发症的几率 重大非心脏手术将进行一项前瞻性观察性临床研究， 可穿戴式健身监测器数据和黄金标准CPET测量的老年人VO 2峰值 威尔康奈尔医学院的外科医生该项目将是第一个使用可穿戴健身监测器， 老年人术前心肺功能筛查和风险分层，并将为 可穿戴协议用于老年人手术风险分层和可穿戴引导的未来研究 预防干预。这一贡献将是显著的，因为它有望改善术前 在计划进行大手术的脆弱老年人中进行筛查， 消费者健康技术。

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.