Using Wearable Devices to Predict Length of Stay For IBD Patients After Bowel Surgery

BACKGROUND: Understanding the factors that contribute to a prolonged length of stay (LOS) for IBD patients after bowel surgery is essential to improving the quality of care provided to these patients. Early ambulation and sleep are important for post-operative recovery (1,2). We used activity and sleep data collected from a wearable biosensor to predict LOS for IBD patients undergoing bowel surgery.

METHODS: We conducted a prospective study of IBD patients undergoing bowel surgery. Patients were provided a Fitbit (Charge or Alta HR, San Francisco, CA) and asked to download and install a proprietary smart phone application (Litmus Health, Austin, TX) for collection of step and sleep data. We also collected sociodemographic and clinical data via review of all patients’ medical records. Associations were assessed using Pearson’s correlation coefficient (r).

RESULTS: Our final sample included 22 patients (17 CD, 5 UC), 4 of whom were excluded from analysis of sleep data only. At time of surgery, mean age was 40.6 years, and the mean BMI was 27.33 kg/m². The median LOS was 5 days (IQR, 4-6.75 days). Compliance wearing Fitbit was 81.5% for step data collection and 64.1% for sleep data collection. There was a significant increase in step count from post-operative day 1 (POD1) to POD5 (r = 0.33, P = 0.015). Between POD1 and POD5, an additional POD was associated with a 421-step increase in step count. However, Pearson’s correlation analysis failed to reveal significant associations of sleep duration and sleep efficiency with post-operative days (P > 0.05). Furthermore, mean daily steps, mean sleep duration, or mean sleep efficiency was not significantly associated with post-operative LOS (r = -0.14, P = 0.52; r = 0.22, P = 0.37; r = -0.12, P = 0.64 respectively). However, a longer sleep duration on POD5 was associated with a longer LOS (r = 0.87, P = 0.026), while a higher sleep efficiency on POD5 was associated with a shorter LOS (r = -0.88, P = 0.019). Moreover, a more positive change in sleep duration from POD4-5 was associated with a longer LOS (r = 0.95, P = 0.003), whereas a more positive change in sleep efficiency from POD4-5 was associated with a shorter LOS (r = -0.92, P = 0.011).

CONCLUSION(S): This is the first study to characterize associations of physical activity and sleep quality with LOS for IBD patients after bowel surgery. We found a significant increase in step count from POD1 to POD5. We also demonstrated that longer sleep duration or lower sleep efficiency on POD5 was associated with a longer LOS. More positive change in sleep duration or more negative change in sleep efficiency from POD4-5 was associated with a longer LOS. We plan to conduct an interventional study to assess the effect of physical activity and sleep quality on LOS for IBD patients after bowel surgery.