Association between preoperative activity levels and postoperative complications in adult spinal deformity surgery

Purpose: Adult spinal deformity (ASD) is a condition associated with significant pain, disability, and high complication rates after surgery, reaching 38–71%. These complications significantly impact recovery, which often takes over a year. Efforts to mitigate complications have focused on preoperative risk stratification using factors such as frailty and patient demographics. Emerging evidence suggests that preoperative mobility and targeted interventions, such as prehabilitation programs, may improve surgical outcomes. This study evaluates the relationship between preoperative activity levels, measured through wearable device, and postoperative complications in ASD surgery. Methods: This was a prospective cohort study including patients aged 21–85 years undergoing surgery for ASD. Participants were passively monitored before surgery using Fitbit trackers. Raw Fitbit data were extracted at the minute level and underwent feature engineering to derive meaningful clinical metrics. Activity features included activity amount (i.e. step count) and activity intensity (i.e. peak 30-min cadence) measures. Patients’ characteristics and postoperative complications were extracted from Electronic Health Records. A Mann–Whitney U test was used to assess differences in activity metrics between patients with and without complications. Results: A total of 23 ASD patients were enrolled, with an average age of 66.6 years and an average of 10.4 fusion levels. All patients were fused to the pelvis, with 35% (8 patients) experiencing perioperative complications and 13% readmitted within 30 days. Complications included DVT, AKI, SSI, wound dehiscence, and reoperation. Patients with higher preoperative activity levels, demonstrated fewer complications. Significant differences were observed between patients with complications and those without in several activity metrics, including steps per activity bout (44.5 vs. 81.0; p = 0.017), active time per bout (1.78 vs. 2.59; p = 0.028), steps per minute of activity (23.5 vs. 29.1; p = 0.02), and maximum 30-min cadence (40.1 vs. 58.6; p = 0.04). Conclusion: Increased preoperative activity levels is associated with reduced complications after ASD surgery. Larger studies are needed to validate these findings, identify critical activity metrics, and establish thresholds for optimizing outcomes. These results highlight the potential benefits of prehabilitation in improving surgical outcomes for ASD patients.