IMPACT OF FRAILTY ON PHYSICAL ACTIVITY IN THE POST-OPERATIVE PERIOD AFTER LIVER TRANSPLANT SURGERY; PILOT STUDY USING FITBIT WATCH

Document Type

Conference Proceeding

Publication Date

10-1-2022

Publication Title

Hepatology

Keywords

adult, age, brain disease, clinical article, cohort analysis, conference abstract, controlled study, exercise intensity, female, frailty, hepatic encephalopathy, human, length of stay, liver graft, male, physical activity, pilot study, postoperative period, sedentary time, surgery

Abstract

Background: Several studies highlight the negative impact of physical frailty on waitlist mortality and post-transplant outcomes for liver transplant (LT) recipients. Although pre-and post-transplant physical activity are important determinants of long-term health after LT, patient's and provider physical activity assessments do not reliably indicate actual performance. This pilot study aimed to evaluate the utility of a PAM in tracking postoperative biophysical data after LT and the impact of pre-transplant frailty on post-operative physical activity. Methods: 49 adult LT candidates were enrolled in the study between February 2021 and February 2022 after being screened for inclusion. LT candidates were excluded if they were undergoing multi-organ transplant, were intubated, or had severe hepatic encephalopathy prior to transplant. Liver Frailty Index (LFI) was performed pre-transplant and on post-operative days (POD) 30 and 60. All patients were provided with a Fitbit® Inspire 2 watch and were instructed to wear it continuously for the duration of the study. Biophysical data including daily steps and exercise intensity duration/ distance was collected using the Fitbit® Inspire 2 watch. Results: 35 patients with complete frailty and PAM data were included in the final cohort. The average daily steps during the first 30 days after LT correlated negatively with increasing age (r -0.52, p=0.001) and longer hospital length of stay (r -0.43, p=0.01). According to pre-transplant LFI, the patients were categorized into: Frail (n=15, 43%) and non-frail (n=21, 57%). Baseline characteristics between both groups were similar except for increased proportion of encephalopathy in frail patients compared to non-frail patients (86% vs. 38% respectively; p=0.005). Based on pre-LT LFI, 'frail' patients' had lower mean daily steps during the first 30 days after LT compared to 'non-frail' patients (steps [SD]: 3045 [2156] vs. 1557 [1269] respectively; p=0.02) [Figure 1A]. According to POD 30 LFI: 'frail' patients had lower mean daily steps during POD 31-60 compared to 'non-frail' patients (steps [SD]: 5563 [2935] vs. 2975 [2733] respectively; p=0.02) [Figure 1B]. Conclusion: This study demonstrated the usefulness of a PAM for tracking patient's physical activity after LT. Understanding the impact of pre-transplant frailty can lead to individualized post-operative interventions for 'frail' patients after LT to improve physical activity, decrease sedentary time, and lead to better postoperative healing.

Volume

76

First Page

S458

Last Page

S459

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