The Impact of Social and Environmental Factors on Preoperative Fitness

Recent research led by Lancaster University highlights the significant influence that social and environmental determinants have on patients' physical readiness before surgery. The study, conducted by Ph.D. researcher Dr. Donna Shrestha at Lancaster Medical School, emphasizes how socioeconomic disparities can affect cardiorespiratory fitness, which is a vital predictor of surgical outcomes. Dr. Shrestha explains that patients from socioeconomically deprived backgrounds tend to have lower levels of fitness at the point of preoperative assessment, potentially contributing to poorer surgical results.

The investigation analyzed data from over 3,300 patients at a major NHS hospital who underwent cardiopulmonary exercise testing (CPET). This objective assessment measures cardiorespiratory fitness, providing critical information to clinicians to evaluate surgical risk, optimize prehabilitation strategies, and personalize perioperative care. The findings revealed that individuals from deprived areas were generally younger, had higher BMI, and were more likely to smoke or have multiple health conditions.

Notably, patients from the most deprived quintile exhibited lower peak oxygen consumption (peak V̇O₂), with values averaging 14.8 ml·kg⁻¹·min⁻¹ compared to 16.3 ml·kg⁻¹·min⁻¹ in the least deprived group. An anaerobic threshold below 11 ml·kg⁻¹·min⁻¹ was more common among these patients and is associated with increased risks of adverse surgical outcomes. Importantly, deprivation emerged as an independent risk factor for reduced fitness, even after accounting for other variables like age, sex, BMI, and lung function.

The study also identified that social determinants—including education level, income, air quality, and access to green spaces—exert a small but meaningful effect on preoperative health indicators. Dr. Shrestha emphasizes that understanding these social and environmental barriers is crucial for designing equitable preoperative pathways. She advocates for targeted interventions to support disadvantaged patients, enhancing their resilience and ultimately leading to fairer surgical outcomes.

This research underscores the importance of considering broader social factors in healthcare planning and highlights the potential benefits of tailored prehabilitation programs to improve surgical readiness for vulnerable populations.

Source: https://medicalxpress.com/news/2025-08-social-factors-patients-surgery.html