2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T7ae,Surgical recovery is dependent on physiologic reserve, functional capacity, and wellness status. We sought to delineate the association of perioperative changes in daily steps, heart rate variability (HRV), and self-reported wellness with length of stay, complications and readmissions. Adults undergoing inpatient surgery with ≥30 preoperative and ≥30 postoperative days of data were identified from the All of Us database. Exposures included postoperative changes in daily steps and heart rate variability (HRV) relative to their preoperative baseline. Wellness, using the "SPADE" composite score was examined in a sensitivity analysis. Multivariable regression analyses, adjusted for relevant factors, were used to assess outcomes, including length of stay (LOS), 30-/90-day complications, and readmissions. Among 66,345 patients who underwent a surgical procedure, 1,965 patients (mean age 50.4 years, 69.5% female) were included in the final analytic cohort. Each postoperative +1,000 steps/day relative to preoperative baseline was associated with reduced LOS (incidence rate ratio [IRR]=0.94, 95%CI 0.90-0.99) and lower odds of 30-day (adjusted odds ratio [aOR]=0.83, 95%CI 0.69-1.00) and 90-day (aOR=0.82, 95%CI 0.70-0.96) complications. Incremental increases in steps were also associated with lower odds of 30-day (aOR=0.85, 95% CI 0.76-0.96) and 90-day readmission (aOR=0.84, 95%CI 0.75-0.94). Postoperative HRV changes and self-reported wellness were not associated with any post-operative outcome (p>0.05). Postoperative step count was the most actionable correlate of recovery across endpoints, whereas postoperative HRV change and self-reported wellness conferred limited independent prognostic value. These findings support integrating wearables into ERAS as preoperative HRV-informed triage and postoperative step-guided recovery, while emphasizing less reliance on subjective patient reported measures to inform discharge or clinical decisions.31:Ta11, Background: Surgical recovery is dependent on physiologic reserve, functional capacity, and wellness status. We sought to delineate the association of perioperative changes in daily steps, heart rate variability (HRV), and self-reported wellness with length of stay, complications and readmissions. Study design: Adults undergoing inpatient surgery with ≥30 preoperative and ≥30 postoperative days of data were identified from the All of Us database. Exposures included postoperative changes in daily steps and heart rate variability (HRV) relative to their preoperative baseline. Wellness, using the “SPADE” composite score was examined in a sensitivity analysis. Multivariable regression analyses, adjusted for relevant factors, were used to assess outcomes, including length of stay (LOS), 30-/90-day complications, and readmissions. Results: Among 66,345 patients who underwent a surgical procedure, 1,965 patients (mean age 50.4 years, 69.5% female) were included in the final analytic cohort. Each postoperative +1,000 steps/day relative to preoperative baseline was associated with reduced LOS (incidence rate ratio [IRR]=0.94, 95%CI 0.90–0.99) and lower odds of 30-day (adjusted odds ratio [aOR]=0.83, 95%CI 0.69–1.00) and 90-day (aOR=0.82, 95%CI 0.70–0.96) complications. Incremental increases in steps were also associated with lower odds of 30-day (aOR=0.85, 95% CI 0.76–0.96) and 90-day readmission (aOR=0.84, 95%CI 0.75–0.94). Postoperative HRV changes and self-reported wellness were not associated with any post-operative outcome (p>0.05). Conclusions: Postoperative step count was the most actionable correlate of recovery across endpoints, whereas postoperative HRV change and self-reported wellness conferred limited independent prognostic value. These findings support integrating wearables into ERAS as preoperative HRV-informed triage and postoperative step-guided recovery, while emphasizing less reliance on subjective patient reported measures to inform discharge or clinical decisions. 32:Tbbd, Background: Exercise and nutrition-based prehabilitation programs are promising emerging strategies for enhancing surgical recovery. However, prior studies have reported mixed findings regarding their impact on postoperative outcomes. The purpose of this study is to investigate the efficacy of exercise and nutrition-based prehabilitation on postoperative outcomes, including length-of-stay (LOS), complications, quality-of-life (QoL), pain, and mental health. Methods: A systematic review and meta-analysis was conducted, using MEDLINE, Cochrane Central, EMBASE, and Web of Science, following PRISMA guidelines. Studies published between 2004 and 2024 were identified with search terms including “prehabilitation,” “exercise,” “nutrition,” and “surgery.” Eligible studies (n=293) were randomized controlled trials (RCTs) evaluating exercise or nutrition-based prehabilitation programs and reporting LOS and complications as primary outcomes. Secondary outcomes included QoL, pain, and mental health scores. Random-effects meta-analyses estimated pooled effect sizes. Results: 23 RCTs were included (2,182 participants). Exercise or nutrition-based prehabilitation reduced complications (odds ratio (OR) 0.52. 95% confidence interval (CI):0.35,0.78, p<0.002, I 2 =47.1%) and LOS (mean difference (MD) -0.44 days, 95% CI:-0.78,-0.11, p=0.01, I 2 =44.8%) compared to standard treatment. When comparing interventions, nutrition only had a greater reduction in LOS than exercise only (MD -1.09 days, 95% CI:-1.72,-0.47 vs. MD -0.20 days, 95% CI: -0.51, 0.09; p=0.01). While QoL was not reported in nutrition only RCTs, exercise alone improved QoL measures (standardized mean difference 0.94, 95% CI: 0.24,1.64, p=0.01, I 2 =93.6%) compared to standard treatment. Conclusion: Exercise or nutrition-based prehabilitation programs reduce LOS and complications across multiple surgical contexts. Further work is needed to elucidate the impact of different intervention protocols and their impact on postoperative outcomes. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Surgical Recovery: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Surgical Recovery (condition). 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Each postoperative +1,000 steps/day relative to preoperative baseline was associated with reduced LOS (incidence rate ratio [IRR]=0.94, 95%CI 0.90-0.99) and lower odds of 30-day (adjusted odds ratio [aOR]=0.83, 95%CI 0.69-1.00) and 90-day (aOR=0.82, 95%CI 0.70-0.96) complications. Incremental increases in steps were also associated with lower odds of 30-day (aOR=0.85, 95% CI 0.76-0.96) and 90-day readmission (aOR=0.84, 95%CI 0.75-0.94). Postoperative HRV changes and self-reported wellness were not associated with any post-operative outcome (p>0.05).","abstract":"$30","keywords":["Heart rate variability (HRV)","Length of stay","Patient-reported outcomes (PROMs)","Perioperative risk stratification","Postoperative complications","RMSSD","Readmission","SPADE","Step count","Wearable devices"],"pubmed_id":"42089531","conclusions":"","publication_date":"2026-05-06T00:00:00"},"crossref":{"DOI":"10.1097/xcs.0000000000001857","URL":"https://doi.org/10.1097/xcs.0000000000001857","ISSN":["1072-7515","1879-1190"],"link":[{"URL":"https://journals.lww.com/10.1097/XCS.0000000000001857","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Association of Perioperative Steps and Heart Rate Variability from Wearable Devices with Surgical Outcomes"],"author":[{"given":"Abdulaziz","family":"Elemosho","sequence":"first","affiliation":[{"name":"Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH"}]},{"given":"Odysseas P","family":"Chatzipanagiotou","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH"}]},{"given":"Meher","family":"Angez","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH"}]},{"given":"Timothy M","family":"Pawlik","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH"}]}],"issued":{"date-parts":[[2026,5,6]]},"member":"276","prefix":"10.1097","source":"Crossref","volume":null,"created":{"date-time":"2026-05-06T12:05:04Z","timestamp":1778069104000,"date-parts":[[2026,5,6]]},"indexed":{"date-time":"2026-05-06T12:20:43Z","timestamp":1778070043228,"date-parts":[[2026,5,6]]},"subject":[],"abstract":"$31","language":"en","relation":{},"resource":{"primary":{"URL":"https://journals.lww.com/10.1097/XCS.0000000000001857"}},"subtitle":[],"deposited":{"date-time":"2026-05-06T12:05:04Z","timestamp":1778069104000,"date-parts":[[2026,5,6]]},"issn-type":[{"type":"print","value":"1072-7515"},{"type":"electronic","value":"1879-1190"}],"published":{"date-parts":[[2026,5,6]]},"publisher":"Ovid Technologies (Wolters Kluwer Health)","reference":null,"short-title":[],"update-policy":"https://doi.org/10.1097/lww.0000000000001000","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"original-title":[],"container-title":["Journal of the American College of Surgeons"],"reference-count":0,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,5,6]]},"references-count":0,"short-container-title":[],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1097/xcs.0000000000001857","is_oa":false,"title":"Association of Perioperative Steps and Heart Rate Variability from Wearable Devices with Surgical Outcomes","updated":"2026-05-07T14:04:23+00:00","published_date":"2026-05-06","best_oa_location":null}},"created_at":"2026-05-10T13:20:42.595Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1097/xcs.0000000000001857","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001857","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001857","tag_type":"condition","value":"Surgical Recovery","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001857","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001857","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001857","tag_type":"modality","value":"Wearable Device Monitoring","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001857","tag_type":"sample_size","value":"n=1965","value_numeric":1965},{"paper_doi":"10.1097/xcs.0000000000001857","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001857","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001857","tag_type":"warning","value":"Only ~3% of the total surgical cohort met inclusion criteria (wearable data completeness), which likely introduces significant selection bias — results may not generalize to typical surgical populations.","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001857","tag_type":"warning","value":"Surgery types were not individually analyzed; step-count thresholds and HRV findings may vary substantially by procedure.","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001857","tag_type":"warning","value":"The 'impact_flag' of practice_changing reflects the authors' strong advocacy for wearable integration into ERAS, but the observational design and highly selected sample warrant caution before clinical adoption.","value_numeric":null}],"summaries":{"what_studied":"Among 1,965 adults (mean age 50.4 years, 69.5% female) from the All of Us database who underwent inpatient surgery with ≥30 pre- and ≥30 postoperative days of wearable data, this study examined whether postoperative changes in daily step count, heart rate variability (HRV), and self-reported wellness (SPADE score) were associated with length of stay (LOS), 30/90-day complications, and readmissions.","key_result":"Each postoperative +1,000 steps/day vs. preoperative baseline was linked to shorter LOS (IRR 0.94, 95% CI 0.90–0.99), lower 30-day complications (aOR 0.83), lower 90-day complications (aOR 0.82), lower 30-day readmission (aOR 0.85), and lower 90-day readmission (aOR 0.84); postoperative HRV change and self-reported wellness showed no independent association with any outcome (p>0.05).","limitations":"- Only ~3% of the surgical cohort (1,965/66,345) met the data completeness threshold, raising concerns about selection bias toward more health-engaged, tech-savvy patients.\n- Observational design from a research registry prevents causal inference; residual confounding cannot be excluded.\n- Surgery type was not uniformly stratified, so step-count benchmarks may not generalize across procedure categories.","practice_takeaway":"Encourage patients to walk more after surgery — each additional 1,000 steps/day above their personal baseline meaningfully reduces complications and readmissions. Consider integrating postoperative step monitoring from wearables into ERAS protocols as an objective recovery metric, while relying less on subjective wellness scores alone for discharge decisions."}},{"doi":"10.1097/xcs.0000000000001891","pmid":null,"title":"Exercise-Based and Nutrition-Based Prehabilitation Programs in Surgery: A Systematic Review and Meta-Analysis","journal_title":"Journal of the American College of Surgeons","journal_issn":"1072-7515","published_at":"2026-04-29T00:00:00.000Z","url":"https://doi.org/10.1097/xcs.0000000000001891","source_score":96,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-03","doi":"10.1097/xcs.0000000000001891","days":"14","issn":"1072-7515","rank":"1","field":"Clinical Medicine","score":"96","category":"Surgery","categories":["Surgery"],"_categories":["Surgery"]},"pubmed":null,"crossref":{"DOI":"10.1097/xcs.0000000000001891","URL":"https://doi.org/10.1097/xcs.0000000000001891","ISSN":["1072-7515","1879-1190"],"link":[{"URL":"https://journals.lww.com/10.1097/XCS.0000000000001891","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Exercise-Based and Nutrition-Based Prehabilitation Programs in Surgery: A Systematic Review and Meta-Analysis"],"author":[{"given":"Catherine T","family":"Cascavita","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Los Angeles, David Geffen School of Medicine and the Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA"}]},{"given":"Anne E","family":"Hall","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Los Angeles, David Geffen School of Medicine and the Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA"}]},{"given":"Kaavian","family":"Shariati","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Los Angeles, David Geffen School of Medicine and the Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA"}]},{"given":"Jose M","family":"Chevalier","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Los Angeles, David Geffen School of Medicine and the Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA"}]},{"given":"Alexander A","family":"Argame","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Los Angeles, David Geffen School of Medicine and the Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA"},{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA"}]},{"given":"Nghiem H","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Los Angeles, David Geffen School of Medicine and the Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA"},{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA"}]},{"given":"Chi-Hong","family":"Tseng","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine & Health Services Research, Internal Medicine-Pediatrics and Preventive Medicine Section, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA USA"}]},{"given":"Marco A","family":"Hidalgo","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine & Health Services Research, Internal Medicine-Pediatrics and Preventive Medicine Section, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA USA"},{"name":"UCLA Gender Health Program, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA"}]},{"given":"Justine C","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Los Angeles, David Geffen School of Medicine and the Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA"},{"name":"UCLA Gender Health Program, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA"}]},{"given":null,"family":null,"sequence":"additional","affiliation":[]}],"issued":{"date-parts":[[2026,4,29]]},"member":"276","prefix":"10.1097","source":"Crossref","volume":null,"created":{"date-time":"2026-04-29T12:13:12Z","timestamp":1777464792000,"date-parts":[[2026,4,29]]},"indexed":{"date-time":"2026-05-02T21:03:01Z","timestamp":1777755781754,"date-parts":[[2026,5,2]]},"subject":[],"abstract":"$32","language":"en","relation":{},"resource":{"primary":{"URL":"https://journals.lww.com/10.1097/XCS.0000000000001891"}},"subtitle":[],"deposited":{"date-time":"2026-04-29T12:13:13Z","timestamp":1777464793000,"date-parts":[[2026,4,29]]},"issn-type":[{"type":"print","value":"1072-7515"},{"type":"electronic","value":"1879-1190"}],"published":{"date-parts":[[2026,4,29]]},"publisher":"Ovid Technologies (Wolters Kluwer Health)","reference":null,"short-title":[],"update-policy":"https://doi.org/10.1097/lww.0000000000001000","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"original-title":[],"container-title":["Journal of the American College of Surgeons"],"reference-count":0,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,4,29]]},"references-count":0,"short-container-title":[],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1097/xcs.0000000000001891","is_oa":false,"title":"Exercise-Based and Nutrition-Based Prehabilitation Programs in Surgery: A Systematic Review and Meta-Analysis","updated":"2026-05-03T08:48:54+00:00","published_date":"2026-04-29","best_oa_location":null}},"created_at":"2026-05-07T22:50:48.657Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1097/xcs.0000000000001891","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001891","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001891","tag_type":"condition","value":"Surgical Recovery","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001891","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001891","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001891","tag_type":"modality","value":"Exercise-Based Prehabilitation","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001891","tag_type":"modality","value":"Nutrition-Based Prehabilitation","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001891","tag_type":"sample_size","value":"n=2,182","value_numeric":2182},{"paper_doi":"10.1097/xcs.0000000000001891","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001891","tag_type":"study_design","value":"Systematic Review and Meta-Analysis","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001891","tag_type":"warning","value":"Studies span 2004–2024; variation in prehabilitation protocols across this period may limit comparability of interventions.","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001891","tag_type":"warning","value":"The study covers 'multiple surgical contexts' but does not specify which specialties or procedures were included — generalizability to specific surgery types is unclear.","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001891","tag_type":"warning","value":"The very high heterogeneity for QoL (I²=93.6%) means the pooled QoL estimate should be interpreted with caution.","value_numeric":null}],"summaries":{"what_studied":"Systematic review and meta-analysis of 23 RCTs (n=2,182) evaluating exercise-based and/or nutrition-based prehabilitation programs versus standard treatment across multiple surgical contexts, with primary outcomes of LOS and postoperative complications, and secondary outcomes of QoL, pain, and mental health.","key_result":"Prehabilitation reduced postoperative complications (OR 0.52, 95% CI 0.35–0.78) and shortened LOS (MD −0.44 days, 95% CI −0.78 to −0.11). Nutrition-only programs cut LOS more than exercise-only (MD −1.09 vs −0.20 days; p=0.01). Exercise alone improved QoL (SMD 0.94, 95% CI 0.24–1.64); QoL was not reported for nutrition-only RCTs.","limitations":"- High heterogeneity for QoL outcome (I²=93.6%), limiting confidence in that estimate.\n- Only 23 RCTs met inclusion criteria from 293 identified studies, suggesting a large body of non-RCT or non-standardized evidence was excluded.\n- QoL data were unavailable for nutrition-only trials, preventing direct head-to-head comparison across all outcomes.","practice_takeaway":"Consider adding exercise or nutrition prehabilitation before elective surgery — both cut complications by roughly half and trim hospital stays. Nutrition-focused programs appear to shorten LOS more than exercise alone, so patient-specific barriers and surgical context should guide which modality to prioritize."}}],"initialOffset":2,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Surgical Recovery"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Surgical Recovery"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Surgical Recovery"}}}]]

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