Socioeconomic deprivation linked to lower fitness before surgery, UK study finds

Editor's Note

Patients from socioeconomically deprived areas are more likely to have reduced cardiorespiratory fitness before surgery, potentially contributing to poorer surgical outcomes, MedicalXpress August 12 reports from a study published by PLOS One. The research, led by PhD student Donna Shrestha of Lancaster University Medical School, analyzed preoperative fitness data from more than 3,300 patients undergoing cardiopulmonary exercise testing (CPET) at a large NHS hospital.

As detailed in the article, patients from the most deprived backgrounds were generally younger but had higher BMIs, smoked more frequently, and were more likely to have multiple comorbidities than those from less deprived areas. Objective CPET measures revealed significant fitness disparities: peak oxygen consumption averaged 14.8 ml·kg⁻¹·min⁻¹ in the most deprived quintile compared to 16.3 ml·kg⁻¹·min⁻¹ in the least deprived. The prevalence of an anaerobic threshold below 11 ml·kg⁻¹·min⁻¹, a marker linked to higher surgical risk, was notably higher in the deprived group.

These differences persisted even after adjusting for demographic and clinical factors such as age, sex, BMI, comorbidities, and lung function. Researchers found broader social determinants, including education level, household income, air quality, and access to green space, each explained small but statistically significant portions of the variation in CPET results.

Shrestha sees cardiorespiratory fitness as one of the few modifiable surgical risk factors, making early identification and targeted prehabilitation critical, per the outlet. She emphasized that patients from deprived areas may face limited time and fewer resources to prepare for surgery, showing the importance of designing preoperative care pathways that address both clinical needs and social barriers. The authors concluded that recognizing and addressing the influence of social and environmental factors can help health systems provide more equitable perioperative care.