"Also unique," she added, "is that we started monitoring patients' steps and quality of life before the operation, to establish a baseline level of walking and overall well-being."

By comparing the group's baseline with the number of postoperative steps, the investigators were able to assess recovery of physical function.


Study investigators cited proof from statistical analysis that steps related to functional recovery. They reported that the median (most commonly reported) number of steps that patients took on postoperative day seven strongly correlated with their median score on the comprehensive complication index (15 out of 100). On this scale, patients and health care providers rated the patients' postoperative complications and their individual severity. Higher scores represented more severe problems.

Patients reported on the Web surveys that pain and other symptoms only moderately interfered with activity after they left the hospital (score of 4.2 of 10). However, patients took a median of 1,247 steps on day seven, which was only 19 percent of their median preoperative daily steps.

Postoperative steps were "much lower than expected," said the study's presenting author, Sinziana Dumitra, MD, a surgical oncology fellow at City of Hope.

This finding reinforced the research team's belief that surgeons should routinely track patient-centered results, such as postoperative pain, anxiety, and ability to perform activities of daily living, she said.

Although much research has evaluated patient-centered outcomes, practicing surgeons do not routinely measure and act on these quality-of-care indicators, Dr. Dumitra said. Typically, after a surgical patient's discharge from the hospital, the surgical team relies on a follow-up phone call and later the first follow-up visit to learn whether the patient is walking as instructed or experiencing any problems.

In contrast, the Web-based system that study participants used to rate their symptoms automatically triggers an immediate e-mail to a surgical team nurse when a patient inputs a score above a preset threshold, such as a pain score of at least 4 of 10.

"With our monitoring system, even before the first postoperative follow-up appointment, we have information about the patients' recovery," Dr. Dumitra commented. "We could use that information to call them and say, 'You need to walk more,' or to set them up with physical therapy."

The researchers plan to further study their postoperative monitoring program using real-time data for individual patients. Dr. Sun said they are studying ways to efficiently package the data and send it real-time to both surgeons and patients to help with postoperative care and recovery. Added Dr. Sun: "Perhaps we could even use the data from wireless monitoring to better prepare patients preoperatively for the stress of an operation."

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