Impact of Preoperative Physical Fitness Assessment on Predicting Postoperative Outcomes in Cancer Patients

Abstract

To mitigate surgery-related morbidity and mortality and elevate the standard of care for surgical patients, clinicians must utilize precise preoperative risk assessment tools. Accurate prediction of postoperative outcomes is essential to optimizing surgical planning, reducing complications, and improving patient recovery. Preoperative physiological reserve, encompassing aspects such as physical activity, strength, mobility, and frailty, plays a fundamental role in determining a patient's ability to withstand surgical stress and recover effectively. Traditional risk assessments, while valuable, often lack sensitivity to subtle yet clinically relevant deficits in physical fitness and reserve, underscoring the need for innovative and evidence-based surrogate markers. This study aimed to investigate the predictive value of surrogate markers for preoperative physiological reserve in relation to postoperative outcomes in patients undergoing elective surgery for cancer. By identifying key predictors of adverse outcomes, the study seeks to inform the development of tailored prehabilitation and perioperative care strategies to enhance recovery and reduce surgical risks. We analyzed data from 125 patients undergoing elective surgery for gastric or head and neck cancer (December 2018 to June 2019), using binary logistic regression models adjusted for confounders. Outcomes of interest were: postoperative complications, major complications, need for intermediate care unit admission, prolonged length of stay (>10 days), 30-day readmission, 30-day reintervention, and postoperative burden (defined as the presence of ≥1 adverse postoperative outcome among those listed). Low physical activity (OR, 2.34; [95% CI, 1.03-5.35], p = 0.043) and frailty (OR, 5.73; [95% CI, 1.79-18.34], p = 0.003) increased the probability of intermediate care unit admission. Frailty was also a significant predictor of postoperative burden (OR, 4.58; [95% CI, 1.60-13.08], p = 0.004). Low gait speed was associated with an increased likelihood of reintervention within 30 days (OR, 5.22; [95% CI, 1.23-22.19], p = 0.025), and probable sarcopenia heightened the odds of prolonged hospitalization (OR, 3.18; [95% CI, 1.15-8.81], p = 0.026). The results demonstrate that low physical activity, low gait speed, probable sarcopenia, and frailty are independent predictors of short-term adverse postoperative outcomes. These findings underscore the importance of comprehensive preoperative evaluations that incorporate functional and physiological assessments to identify high-risk patients.