Increasing Step Count After Surgery Confers Significant Recovery Benefit

Elemosho A, Chatzipanagiotou OP, Angez M, Pawlik T. Association of Perioperative Steps and Heart Rate Variability from Wearable Devices with Surgical Outcomes. J Am Coll Surg. May 2026.

As wearable devices become increasingly common, surgeons are now faced with determining which patient-generated metrics are actually useful in assessing postoperative recovery. In this JACS study, Elemosho and colleagues used the All of Us database to evaluate adults undergoing inpatient surgery who had at least 30 days of preoperative and 30 days of postoperative wearable-device data.

Among 66,345 surgical patients, 1,965 met inclusion criteria, with a mean age of 50.4 years and a predominantly female cohort. The authors examined postoperative changes in daily step count and heart rate variability relative to each patient’s preoperative baseline, with self-reported wellness assessed in a sensitivity analysis. Outcomes included length of stay, 30- and 90-day complications, and 30- and 90-day readmissions.

The most clinically actionable finding was that postoperative step count was consistently associated with recovery outcomes, whereas postoperative HRV and self-reported wellness were not. Each additional 1,000 postoperative steps per day relative to baseline was associated with shorter length of stay, lower odds of 90-day complications, and lower odds of both 30- and 90-day readmission; the association with 30-day complications was directionally favorable but borderline, with the confidence interval reaching 1.00.

For surgeons, the practical takeaway is that wearable-derived step count may offer a simple, objective, and patient-specific marker of postoperative recovery that can complement ERAS pathways, discharge planning, and post-discharge surveillance. The study does not suggest that wearables should replace clinical judgment, but it supports the idea that functional recovery—measured by how much a patient is moving compared with their own baseline—may be more useful than more abstract physiologic metrics or subjective wellness scores.