Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital

'Fit for surgery': The relationship between cardiorespiratory fitness and postoperative outcomes

Research output: Contribution to journalReviewpeer-review


  1. Effect of adrenaline on serum mid-regional pro-atrial natriuretic peptide and central blood volume

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. The role of lactate in sepsis and COVID-19: Perspective from contracting skeletal muscle metabolism

    Research output: Contribution to journalReviewpeer-review

  3. Contact events in rugby union and the link to reduced cognition: evidence for impaired redox-regulation of cerebrovascular function

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Glycogen supercompensation is due to increased number, not size, of glycogen particles in human skeletal muscle

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Diagnostic and prognostic performance of Mxa and transfer function analysis-based dynamic cerebral autoregulation metrics

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Inspiratory Muscle Training Enhances Recovery Post COVID-19: A Randomised Controlled Trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Reliability of non-invasive arterial blood pressure measurement in patients with aneurysmal subarachnoid haemorrhage

    Research output: Contribution to journalJournal articleResearchpeer-review

  • George A Rose
  • Richard G Davies
  • Ian R Appadurai
  • Ian M Williams
  • Mohammad Bashir
  • Ronan M G Berg
  • David C Poole
  • Damian M Bailey
View graph of relations

NEW FINDINGS: What is the topic of this review? The relationships and physiological mechanisms underlying the clinical benefits of cardiorespiratory fitness (CRF) in patients undergoing major intra-abdominal surgery. What advances does it highlight? Elevated CRF reduces postoperative morbidity/mortality, thus highlighting the importance of CRF as an independent risk factor. The vascular protection afforded by exercise prehabilitation can further improve surgical risk stratification and postoperative outcomes.

ABSTRACT: Surgery accounts for 7.7% of all deaths globally and the number of procedures is increasing annually. A patient's 'fitness for surgery' describes the ability to tolerate a physiological insult, fundamental to risk assessment and care planning. We have evolved as obligate aerobes that rely on oxygen (O2 ). Systemic O2 consumption can be measured via cardiopulmonary exercise testing (CPET) providing objective metrics of cardiorespiratory fitness (CRF). Impaired CRF is an independent risk factor for mortality and morbidity. The perioperative period is associated with increased O2 demand, which if not met leads to O2 deficit, the magnitude and duration of which dictates organ failure and ultimately death. CRF is by far the greatest modifiable risk factor, and optimal exercise interventions are currently under investigation in patient prehabilitation programmes. However, current practice demonstrates potential for up to 60% of patients, who undergo preoperative CPET, to have their fitness incorrectly stratified. To optimise this work we must improve the detection of CRF and reduce potential for interpretive error that may misinform risk classification and subsequent patient care, better quantify risk by expressing the power of CRF to predict mortality and morbidity compared to traditional cardiovascular risk factors, and improve patient interventions with the capacity to further enhance vascular adaptation. Thus, a better understanding of CRF, used to determine fitness for surgery, will enable both clinicians and exercise physiologists to further refine patient care and management to improve survival.

Original languageEnglish
JournalExperimental Physiology
Issue number8
Pages (from-to)787-799
Number of pages13
Publication statusPublished - Aug 2022

Bibliographical note

This article is protected by copyright. All rights reserved.

    Research areas

  • Cardiorespiratory Fitness/physiology, Exercise Test/methods, Exercise/physiology, Humans, Postoperative Period, Risk Assessment, cardiorespiratory fitness, mortality, oxygen transport, physical activity, surgery

ID: 78269342