Returning to baseline daily ambulation after cardiothoracic surgery

Background: Post-operative functional recovery is an important target for recovery after surgery. Return to baseline ambulation following video assisted thoracoscopic surgery (VATS) and cardiac surgery has not been quantified. Walking data is increasingly available with wrist-worn activity trackers and can be used to counsel patients about post-operative recovery. The purpose of this study is to quantify ambulatory recovery for 28 days following VATS and cardiac surgery. Methods: This is a single-institution, prospective cohort study of patients undergoing elective video assisted thoracoscopic and cardiac operations over 3 years. Baseline demographics and peri-operative data were recorded. All participants wore an accelerometer which measured ambulation (steps/day) for ≥3 days pre-operatively and ≥28 days post-operatively. Post-operative ambulatory recovery trajectories were analyzed. Differences in recovery and return to baseline for each cohort were compared. Results: Twenty-one patients undergoing cardiac or thoracic surgery were included. 7 (33%) underwent VATS and 14 (67%) underwent cardiac surgery. For the entire cohort, there was a strong positive correlation between increasing post-operative day and daily steps (ρ=0.853; P<0.001). For VATS patients, there was a strong positive correlation between increasing post-operative day and daily steps (ρ=0.804; P<0.001). For cardiac surgery patients, there was a strong positive correlation between increasing post-operative day and daily steps (ρ=0.894; P<0.001). VATS patients walked more than cardiac patients on post-operative day 1 (P=0.008), although there was no difference on post-operative day 28 (P=0.83). Peak recovery for VATS patients was during week 1 with return to baseline pre-operative levels at post-operative day 9. Peak recovery for cardiac surgery patients was during week 4 with return to baseline pre-operative levels at post-operative day 26. Conclusions: Ambulatory recovery is directly related to increasing post-operative day after VATS and cardiac surgery. VATS patients are without statistical difference from baseline preoperative ambulation levels within 2 weeks of their operation. In contrast, cardiac surgery patients require 4 weeks to reach ambulation levels without statistical difference from baseline. This data can be used to counsel patients regarding their expected recovery following VATS and cardiac surgery.