How social factors influence patients’ fitness before surgery

Social and environmental factors may influence fitness ahead of surgery reveals research led by Lancaster University.

The study was led by PhD researcher Dr Donna Shrestha from Lancaster Medical School, where her research focuses on health inequalities in the surgical patient pathway. She is also a senior resident doctor with a specialist interest in colorectal surgery.

The research published in PLOS ONE suggests that patients from more socioeconomically deprived areas may have lower cardiorespiratory fitness at the time of preoperative assessment.

Dr Shrestha said: “The study reveals a clear social gradient in physical resilience before surgery. This difference in fitness could help explain why patients from deprived areas often have poorer surgical outcomes. Cardiorespiratory fitness is one of the few modifiable risk factors before an operation. Identifying patients who might benefit most from early intervention and ensuring they get that support is vital if we want fairer surgical outcomes.”

The researchers analysed data from over 3,300 patients at a large NHS hospital who underwent Cardiopulmonary exercise testing (CPET). CPET provides objective, effort-based measures of cardiorespiratory fitness, which can help clinicians assess surgical risk, guide prehabilitation efforts, and tailor perioperative care.

Patients from more deprived backgrounds were younger, had higher BMIs, and were more likely to smoke or have multiple comorbidities than those from less deprived areas.

• Cardiorespiratory fitness was significantly lower in the most deprived groups. For example, peak oxygen consumption (peak V̇O₂) was 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. An anaerobic threshold below 11 ml·kg⁻¹·min⁻¹ is linked with poor surgical outcomes and was more prevalent among deprived patients.
• Deprivation remained an independent risk factor for poorer CPET results, even after adjusting for age, sex, BMI, comorbidities, and lung function.
• A range of wider social determinants such as education, income, air quality, green space availability explained small but significant portions of the variance in CPET outcomes.

The findings suggest that social and environmental factors—like income, education, air quality, and access to green space—can have small but significant impact on a person’s physical readiness for surgery. Understanding these influences helps the NHS and care teams tailor support for patients more effectively.

Dr Shrestha said: “Surgery is a major physical challenge. Patients from deprived areas often have less time and fewer resources to improve their health before an operation. By understanding the social and environmental barriers they face, we can design preoperative pathways that are not just clinically effective, but equitable.”

The other research authors included Cliff Shelton and Chris Gaffney from Lancaster Medical School, Nicholas Wisely from Wythenshawe Hospital and the University of Manchester, Theodoros Bampouras from Liverpool John Moores University and Daren Subar from East Lancashire Hospitals NHS Trust.

The research was funded by Collaboration North West Coast (NIHR ARC NWC).