PROJECT SUMMARY Major surgeries are becoming increasingly common in older adults with approximately half of the population over the age of 65 years requiring surgery at least once during the remainder of their lives. This trend is highly concerning for public health, because older adults are well known to suffer high rates of postoperative morbidity and mortality following major surgeries due to diminished functional capacity, comorbidities, frailty, and lack of access to comprehensive geriatric care. Preoperative risk stratification is of particular importance in geriatric surgery to identify patients at increased risk of surgical complications, to fully inform patients and providers in their surgical decision-making, and to determine if additional preoperative testing or medical interventions are required prior to surgery. Functional capacity as measured by maximum oxygen uptake (VO2peak), is an important factor in older adults presenting for major surgery, because it is highly correlated to postoperative morbidity and mortality, provides a holistic picture of cardiorespiratory fitness, and is modifiable with prehabilitation exercise programs. Although direct measurement of maximum oxygen uptake is possible with sophisticated cardiopulmonary exercise testing (CPET), wide-scale implementation of this measurement is not practical due to the need for specialized equipment, trained personnel, and financial and logistical challenges. Wearable fitness monitors capable of remote mobility and physiology monitoring offer an alternative to direct cardiopulmonary exercise measurement through indirect prediction of functional capacity using cardiorespiratory fitness metrics, such as exercise intensity and heart rate reserve. The proposed research aims to: (1) assess the accuracy of wearable devices for predicting VO2peak in older adults; and (2) evaluate the odds of perioperative complications using wearable-predicted VO2peak in older adults undergoing major noncardiac surgery. A prospective observational clinical study will be conducted to measure preoperative wearable fitness monitor data and gold-standard CPET-measured VO2peak in older adults scheduled for major surgery at Weill Cornell Medical College. This project will be the first to use wearable fitness monitors for preoperative cardiorespiratory fitness screening and risk stratification in older adults, and will set the stage for future studies of wearable protocols for surgical risk stratification in older adults and wearable-guided prehabilitation interventions. The contribution will be significant because it is expected to improve preoperative screening in vulnerable older adults scheduled for major surgery with practical, cost effective and accessible consumer health technology.

PROJECT NARRATIVE The proposed research is relevant to public health because major surgeries are increasingly common in older adults and are associated with poor patient outcomes. We propose to study wearable fitness monitors as predictors of functional capacity and postoperative morbidity and mortality in older adults undergoing major surgery. This study will lay the foundation for future development of wearable-based risk stratification protocols and preoperative exercise interventions aimed at optimizing functional capacity.