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

项目总结 在约占总人口一半的老年人中，大手术变得越来越常见 65岁以上的人在其余生中至少需要做一次手术。这一趋势是高度 关注公共健康，因为众所周知，老年人的术后死亡率很高 大手术后的发病率和死亡率是由于功能能力减弱、合并症、虚弱、 以及缺乏获得全面老年护理的机会。术前风险分层在以下方面尤为重要 老年外科手术，以识别手术并发症风险增加的患者，充分告知患者和 在他们的手术决策中，并确定是否有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容量 (VO2峰值)，是老年人进行大手术的一个重要因素，因为它与 术后发病率和死亡率，提供了心肺健康的整体情况，并且是可修改的 实施康复训练计划。尽管直接测量最大摄氧量是可能的 通过复杂的心肺运动测试(CPET)，这种测量的广泛实施是 不切实际，因为需要专门设备、训练有素的人员以及财政和后勤 挑战。能够远程移动和生理监测的可穿戴健康监测器提供 通过间接预测功能容量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。建议数 研究旨在：(1)评估可穿戴设备预测老年人VO2峰值的准确性；以及(2) 使用可穿戴设备预测的VO2峰值评估老年人接受手术的围术期并发症的几率 主要的非心脏手术。将进行一项前瞻性观察性临床研究，以测量术前 可穿戴式健康监测数据和黄金标准CPET测量的老年人VO2峰值定于主要 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康监测器 对老年人进行术前心肺适应性筛查和风险分层，并将为 可穿戴设备在老年人手术风险分层和可穿戴设备引导下的未来研究 康复干预。这一贡献将是巨大的，因为它有望改善手术前的状况 对计划进行大手术的脆弱老年人进行筛查，实用、经济有效且容易获得 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.