@Article{info:doi/10.2196/46629,
author="Fuchita, Mikita
and Ridgeway, J. Kyle
and Kimzey, Clinton
and Melanson, L. Edward
and Fernandez-Bustamante, Ana",
title="Accelerometer-Measured Inpatient Physical Activity and Associated Outcomes After Major Abdominal Surgery: Systematic Review",
journal="Interact J Med Res",
year="2023",
month="May",
day="15",
volume="12",
pages="e46629",
keywords="abdominal surgery",
keywords="accelerometry",
keywords="early mobilization",
keywords="physical activity",
keywords="postoperative care",
keywords="wearable",
abstract="Background: It remains unclear how inpatient physical activity after major abdominal surgery affects outcomes. Accelerometer research may provide further evidence for postoperative mobilization. Objective: We aimed to summarize the current literature evaluating the impact of accelerometer-measured postoperative physical activity on outcomes after major abdominal surgery. Methods: We searched PubMed and Google Scholar in October 2021 to conduct a systematic review. Studies were included if they used accelerometers to measure inpatient physical behaviors immediately after major abdominal surgery, defined as any nonobstetric procedures performed under general anesthesia requiring hospital admission. Studies were eligible only if they evaluated the effects of physical activity on postoperative outcomes such as postoperative complications, return of gastrointestinal function, hospital length of stay, discharge destination, and readmissions. We excluded studies involving participants aged <18 years. Risk of bias was assessed using the risk-of-bias assessment tool for nonrandomized studies (RoBANS) for observational studies and the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for randomized controlled trials (RCTs). Findings were summarized by qualitative synthesis. Results: We identified 15 studies. Risk of bias was high in 14 (93\%) of the 15 studies. Most of the studies (11/15, 73\%) had sample sizes of <100. Of the 15 studies, 13 (87\%) included the general surgery population, 1 (7\%) was a study of patients who had undergone gynecologic surgery, and 1 (7\%) included a mixed (abdominal, thoracic, gynecologic, and orthopedic) surgical population. Of the 15 studies, 12 (80\%) used consumer-grade accelerometers to measure physical behaviors. Step count was the most commonly reported physical activity outcome (12/15, 80\%). In the observational studies (9/15, 60\%), increased physical activity during the immediate postoperative period was associated with earlier return of gastrointestinal function, fewer surgical and pulmonary complications, shorter hospital length of stay, and fewer readmissions. In the RCTs (6/15, 40\%), only 1 (17\%) of the 6 studies demonstrated improved outcomes (shorter time to flatus and hospital length of stay) when a mobility-enhancing intervention was compared with usual care. Notably, mobility-enhancing interventions used in 4 (67\%) of the 6 RCTs did not result in increased postoperative physical activity. Conclusions: Although observational studies show strong associations between postoperative physical activity and outcomes after major abdominal surgery, RCTs have not proved the benefit of mobility-enhancing interventions compared with usual care. The overall risk of bias was high, and we could not synthesize specific recommendations for postoperative mobilization. Future research would benefit from improving study design, increasing methodologic rigor, and measuring physical behaviors beyond step counts to understand the impact of postoperative mobilization on outcomes after major abdominal surgery. ",
doi="10.2196/46629",
url="https://www.i-jmr.org/2023/1/e46629",
url="http://www.ncbi.nlm.nih.gov/pubmed/37184924"
}


@Article{info:doi/10.2196/45898,
author="Zhu, Zhihui
and Li, Yuehuan
and Zhang, Fan
and Steiger, Stefanie
and Guo, Cheng
and Liu, Nan
and Lu, Jiakai
and Fan, Guangpu
and Wu, Wenbo
and Wu, Mingying
and Wang, Huaibin
and Xu, Dong
and Chen, Yu
and Zhu, Junming
and Meng, Xu
and Hou, Xiaotong
and Anders, Hans-Joachim
and Ye, Jian
and Zheng, Zhe
and Li, Chenyu
and Zhang, Haibo",
title="Prediction of Male Coronary Artery Bypass Grafting Outcomes Using Body Surface Area Weighted Left Ventricular End-diastolic Diameter: Multicenter Retrospective Cohort Study",
journal="Interact J Med Res",
year="2023",
month="Mar",
day="23",
volume="12",
pages="e45898",
keywords="body surface area",
keywords="BSA",
keywords="left ventricular end-diastolic diameter",
keywords="LVEDD",
keywords="coronary artery bypass grafting",
keywords="CABG",
keywords="outcomes",
abstract="Background: The presence of a high left ventricular end-diastolic diameter (LVEDD) has been linked to a less favorable outcome in patients undergoing coronary artery bypass grafting (CABG) procedures. However, by taking into consideration the reference of left ventricular size and volume measurements relative to the patient's body surface area (BSA), it has been suggested that the accuracy of the predicting outcomes may be improved. Objective: We propose that BSA weighted LVEDD (bLVEDD) is a more accurate predictor of outcomes in patients undergoing CABG compared to simply using LVEDD alone. Methods: This study was a comprehensive retrospective cohort study that was conducted across multiple medical centers. The inclusion criteria for this study were patients who were admitted for treatment between October 2016 and May 2021. Only elective surgery patients were included in the study, while those undergoing emergency surgery were not considered. All participants in the study received standard care, and their clinical data were collected through the institutional registry in accordance with the guidelines set forth by the Society of Thoracic Surgeons National Adult Cardiac Database. bLVEDD was defined as LVEDD divided by BSA. The primary outcome was in-hospital all-cause mortality (30 days), and the secondary outcomes were postoperative severe adverse events, including use of extracorporeal membrane oxygenation, multiorgan failure, use of intra-aortic balloon pump, postoperative stroke, and postoperative myocardial infarction. Results: In total, 9474 patients from 5 centers under the Chinese Cardiac Surgery Registry were eligible for analysis. We found that a high LVEDD was a negative factor for male patients' mortality (odds ratio 1.44, P<.001) and secondary outcomes. For female patients, LVEDD was associated with secondary outcomes but did not reach statistical differences for morality. bLVEDD showed a strong association with postsurgery mortality (odds ratio 2.70, P<.001), and secondary outcomes changed in parallel with bLVEDD in male patients. However, bLVEDD did not reach statistical differences when fitting either mortality or severer outcomes in female patients. In male patients, the categorical bLVEDD showed high power to predict mortality (area under the curve [AUC] 0.71, P<.001) while BSA (AUC 0.62) and LVEDD (AUC 0.64) both contributed to the risk of mortality but were not as significant as bLVEDD (P<.001). Conclusions: bLVEDD is an important predictor for male mortality in CABG, removing the bias of BSA and showing a strong capability to accurately predict mortality outcomes. Trial Registration: ClinicalTrials.gov NCT02400125; https://clinicaltrials.gov/ct2/show/NCT02400125 ",
doi="10.2196/45898",
url="https://www.i-jmr.org/2023/1/e45898",
url="http://www.ncbi.nlm.nih.gov/pubmed/36951893"
}