Vanderbilt University School of Medicine, Nashville, TN.
From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Ann Plast Surg. 2021 Jun 1;86(6S Suppl 5):S610-S614. doi: 10.1097/SAP.0000000000002698.
Early ambulation and return to preoperative (baseline) ambulatory level is protective against postoperative venous thromboembolism. The duration of decreased physical activity after surgery is unknown for most procedures, as surgeons typically estimate physical recovery based on subjective patient reporting. This study aims to quantify the time it takes to return to baseline ambulatory status after breast reconstruction using actigraphy devices.
Actigraphy devices were used to evaluate preoperative and postoperative physical activity levels in patients undergoing autologous breast reconstruction at a single academic institution. Steps and resting heart rate (HR) were used as metrics of physical activity and physiological state. "Baseline" physical activity was defined by the average daily step count during the 14 days before surgery. "Return to baseline" occurred when the 7-day daily step average was greater than or equal to 95% of their baseline steps. Study participation was considered complete once a patient returned to baseline or surpassed 8 postoperative weeks.
From May 2019 to April 2020, 17 patients were enrolled in the study before deep inferior epigastric perforator breast reconstruction. The mean age was 48.2 years and mean BMI was 27.6. This cohort averaged 7908 ± 3271 preoperative steps. Two patients returned to baseline activity by postoperative day 28. In total, 8 patients returned by postoperative week 8. Preoperative resting HR average was 73.5 ± 9.43 beats per minute. The average resting HR was elevated by 2.59%, 4.28%, and 2.31% at weeks 1, 2, and 3, respectively. The 7-day daily average resting HR had normalized by week 4.
Return to baseline physical activity after surgery may take longer than previously perceived, particularly after physiologically demanding surgeries, such as free flap breast reconstruction. These findings indicate that surgeons may underestimate the impact of surgery on physical decline and, consequently, may undertreat with venous thromboembolism prophylaxis.
早期活动并恢复术前（基线）活动水平可预防术后静脉血栓栓塞。大多数手术术后体力活动减少的持续时间未知，因为外科医生通常根据主观的患者报告来估计身体恢复情况。本研究旨在使用活动记录仪设备量化乳房重建术后恢复到基线活动状态所需的时间。
在一家学术机构，使用活动记录仪设备评估接受自体乳房重建的患者术前和术后的体力活动水平。步数和静息心率（HR）被用作体力活动和生理状态的指标。“基线”体力活动被定义为手术前 14 天内的平均每日步数。当 7 天的每日平均步数大于或等于基线步数的 95%时，就会发生“恢复到基线”。一旦患者恢复到基线或超过 8 个术后周，研究参与就被认为完成。
从 2019 年 5 月至 2020 年 4 月，17 名患者在接受深部腹壁下血管穿支皮瓣乳房重建前参加了这项研究。平均年龄为 48.2 岁，平均 BMI 为 27.6。该队列平均术前步数为 7908±3271 步。有 2 名患者在术后第 28 天恢复到基线活动水平。总共有 8 名患者在术后第 8 周恢复。术前静息 HR 平均为 73.5±9.43 次/分钟。第 1、2 和 3 周，平均静息 HR 分别升高了 2.59%、4.28%和 2.31%。第 4 周时，7 天的每日平均静息 HR 已恢复正常。
手术后恢复到基线体力活动水平可能比以前认为的要长，尤其是在生理要求较高的手术（如游离皮瓣乳房重建）后。这些发现表明外科医生可能低估了手术对身体下降的影响，因此可能会低估静脉血栓栓塞的预防治疗。
