ArticleDigital health
Rest-activity rhythmicity as digital biomarkers of postoperative recovery and complications in children.
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13 authors.
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Abstract
Objective: Surgery and postoperative complications disrupt circadian rhythms. While clinicians recognize the implicit value of circadian rhythms to evaluate postoperative recovery, the absence of a practical means to measure them has limited their exploration and integration into clinical practice in children. Methods: Consumer wearable device (Fitbit) was given to children 3-18 years old who underwent laparoscopic appendectomy for complicated appendicitis and data were collected during postoperative days (POD) 1 to 21. Three novel rest-activity rhythmicity (RAR) metrics were computed from minute-by-minute continuous Fitbit data: (1) Periodicity and (2) Amplitude of the 24-hour Activity Rhythm; and (3) Circadian quotient of the 24-hour heart rate (HR) Rhythm. RAR trajectories were aggregated for patients without postoperative complications and compared against trajectories for patients with complications. Results: Ninety-four patients were included in the analysis (n=13 [14%] with complications). For patients without complications, three RAR metrics gradually increased in intensity until reaching plateaus between POD 11-20 (Periodicity of the 24-hour Activity Rhythm, 95% confidence interval [CI]: POD 9-14; Amplitude of the 24-hour Activity Rhythm, 95% CI: POD 16-24; Circadian quotient of the 24-hour HR Rhythm, 95% CI: POD 9-15). Although the RAR metrics for children with complications increased in intensity, none plateaued during the 21-day study period. Conclusion: Wearable-derived circadian rhythms demonstrated distinct patterns in RAR metrics for children with and without complications during the 21-day study period following appendectomy. This suggests that the RAR may be relevant digital biomarkers to track postoperative recovery and identify complications in pediatric populations.
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