Smartphone and Wearable Activity Monitoring of Mobility Changes: A Marker of Recovery after Skull Base Surgery

Introduction: This article aims to assess the utility of smartphone-based/passive wearable activity monitoring as a marker for recovery after skull base surgical procedures. Can this technology serve as a predictor of return of function and quality of life?

Methods: We selected patients who underwent anterior or lateral skull base surgery at NYU Langone Health who were above the age of 18 and consented to allow activity monitoring through their smartphone devices/wearables for 2 weeks before and up to 6 weeks after their surgery. Demographics, details of treatment, and outcomes metrics were collected. Relationships between demographic variables, mobility metrics, and outcomes (e.g., length of stay [LOS]) were assessed through statistical tests including Fisher’s exact tests, ANOVA tests, and coefficients of determination.

Results: We identified 68 patients, of which, 52 (76%) were female, white (39, 53%), with a median age of 44.0. The most common pathology was meningiomas (27, 40%), followed by pituitary adenomas (19, 28%), vestibular schwannomas (18, 26%), Rathke’s cleft cyst (2, 3%), encephalocele (1, 1.5%), and subependymoma (1, 1.5%). Resection results were predominantly gross total resection (55, 81%), followed by near-total resection (7, 10%), and then subtotal resection (6, 9%). The median length of stay was 3 days. Four patients returned to the operative theatre for cerebrospinal fluid leaks. Of the 68 patients, around one-third were endoscopic endonasal cases (24, 35%), one-third lateral skull base cases (24, 35%), and one-third anterior skull base cases (20, 29%), which varied by race, pathology, resection result, and median length of stay (p < 0.01). Return to preoperative mobility (RPM) was characterized by postsurgical weekly step average divided by the weekly step average 1 week before surgery. On preliminary analysis, there is substantial RPM for all groups at postsurgical week 6 (all cases: 81%, anterior skull base cases: 80%, lateral: 81%, endoscopic: 82%). All four groups also demonstrated a relatively linear rate of return to preoperative mobility versus postsurgical week as follows: all skull base cases (9.5% RPM weekly, coefficient of determination, 0.96), anterior skull base cases (5.9% RPM weekly, coefficient of determination: 0.95), lateral skull base cases (10.5% RPM weekly, coefficient of determination: 0.94), and endoscopic cases (8.5% RPM weekly, coefficient of determination: 0.86). A significant relationship was found between week 1 RPM and length of stay: 51.0% RPM for patients with LOS 1 day versus 14.0% RPM for patients with LOS of 6 days (p < 0.01).

Conclusion: Taken in aggregate, patients undergoing skull base surgery achieved an 81% return to preoperative mobility by the sixth week, although when stratified by anterior, lateral, and endoscopic skull base cases, the rates of return to function varied. Postsurgical weekly step count was found on preliminary analysis to significantly correlate with the length of stay in the hospital. Passive smartphone/wearable activity monitoring may represent a reliable metric for outcome in skull base surgery ([Figs. 1] and [2]).

Publication History

Article published online:
07 February 2025