Steps toward recovery-peri-operative step count as an objective Enhanced Recovery After Surgery implementation metric after gynecologic cancer surgery.

OBJECTIVE

Enhanced Recovery After Surgery pathways have improved post-operative outcomes in gynecologic oncology, yet recovery trajectories vary widely. Objective measures of post-operative mobilization, such as daily step count, may serve as reliable indicators of functional recovery, but their impact remains unclear. This study evaluated the relationship between peri-operative step counts and post-operative outcomes while accounting for established clinical and surgical recovery factors.

METHODS

A prospective cohort study of patients undergoing gynecologic cancer surgery at a single tertiary, university-affiliated center. Participants wore smartwatches to record daily step counts before and after surgery. Demographic, clinical, and surgical data were collected, along with post-operative recovery parameters including pain, narcotic use, duration of urinary catheterization and abdominal drainage, and peri-operative hemoglobin decline. Primary outcomes were hospital length of stay and re-admission rates. Multivariable Poisson generalized estimating equation models were applied to evaluate associations while adjusting for potential confounders.

RESULTS

Seventy-seven women were included. Longer length of stay correlated with older age, greater hemoglobin decline, higher narcotic use, and prolonged urinary catheterization (all p < .01). Higher pre-operative and post-operative daily step counts were significantly associated with shorter length of stay (r = -0.356 and r = -0.318, respectively, both p < .001). Re-admission was associated with catheterization duration, delayed oral intake, and surgical complexity, but not with step counts. After adjusting for models, higher post[operative step counts remained an independent predictor of shorter length of stay (β = -5.12 × 10-5, p = .008), with a diminishing effect over later post-operative days.

CONCLUSION

Early-onset mobilization evaluated by post-operative step counts is independently associated with shorter hospitalization, confirming activity as a robust, modifiable predictor of recovery. Smartwatch-based step monitoring offers accurate, objective mobility assessment, supporting its integration into peri-operative Enhanced Recovery After Surgery pathways to optimize recovery and guide targeted rehabilitation strategies.