PD36-12: Measuring objective recovery of activity levels using wearable devices following open vs intracorporeal robotic cystectomy: secondary outcomes analysis of the iROC randomized trial.
Introduction: Radical cystectomy is associated with significant morbidity and extended recovery time. No previous randomized trials have used objective measures such as fitness trackers to measure recovery in mobility. In this study, we compare recovery of mobility in open and intracorporeal robotic cystectomy in the randomised setting of the iROC trial. Methods: The iROC randomized trial (ClinicalTrials.gov Identifier: NCT03049410) compared recovery following iRARC vs ORC for bladder cancer. Physical activity levels were measured by collecting mean and maximum number of steps taken per day over a 7-day period using Misfit Shine (Fossil Group Inc.) and number of chair-to-stands (CTS) in 30 seconds at baseline, as well as 5 days, 5 weeks and 12 weeks post-operatively. Complications in the post-operative period were measured using the Clavien-Dindo (CD) classification at 30 days (early) and 90 days (late). Results: Among 260 patients who provided wearable device data, there was no difference in average (iRARC 6430 (SD 3189) vs ORC 6550 (SD 2864)) or maximum (iRARC 9659 (SD 5238) vs ORC 9525 (SD 4039)) step-counts at baseline. There was no significant difference in absolute step-counts between iRARC and ORC at any of the post-operative timepoints. However, there was a significant difference in recovery of average steps (iRARC 34.7% vs ORC 24.6%, p=0.042) but not maximum steps favoring iRARC at the 5-day timepoint when compared to baseline, no difference was noted in other timepoints. Recovery of CTS was significantly different at 5 weeks (iRARC 84.6% vs ORC 74.0%, p=0.013) favoring iRARC, but not at 5 days or 12 weeks post-operatively. Early and late major complications (CD=3) were associated with a delayed recovery of maximum steps at 5 weeks (p=0.014) and 12 weeks (p=0.019) respectively, with no difference in average step-counts. Conclusions: Wearable devices offer a new way to measure post-operative recovery. In the randomized setting, iRARC was associated with faster recovery of mobility in the early post-operative period (5 days post-operatively), but this effect was not sustained into the 5th week post-operatively. However, recovery in CTS counts were significantly different at 5 weeks and may be more useful in capturing differences in the later peri-operative period. Major complications were associated with a delayed recovery in step-counts. SOURCE OF Funding: The Urology Foundation and the Champniss Foundation
