Social and environmental factors play a crucial role in influencing a patient’s fitness prior to surgery, according to a recent study conducted by Lancaster University. The research, led by Ph.D. researcher Dr. Donna Shrestha from Lancaster Medical School, sheds light on the impact of health inequalities in the surgical patient pathway. Dr. Shrestha, who is also a senior resident doctor specializing in colorectal surgery, highlighted the importance of understanding the social gradient in physical resilience before surgery.
Published in PLOS One, the study suggests that patients from socioeconomically deprived areas may exhibit lower cardiorespiratory fitness during preoperative assessment. This difference in fitness levels could potentially explain why patients from deprived areas often experience poorer surgical outcomes. Identifying patients who may benefit from early intervention and providing them with the necessary support is crucial for achieving fairer surgical outcomes.
The research analyzed data from over 3,300 patients at a large NHS hospital who underwent cardiopulmonary exercise testing (CPET). CPET offers objective measures of cardiorespiratory fitness, which can aid clinicians in assessing surgical risk, guiding prehabilitation efforts, and customizing perioperative care plans.
Patients from more deprived backgrounds were found to be younger, have higher BMIs, and be more likely to smoke or have multiple comorbidities compared to those from less deprived areas. The study revealed that cardiorespiratory fitness was significantly lower in the most deprived groups, with peak oxygen consumption levels being notably lower in these patients.
Deprivation emerged as an independent risk factor for poorer CPET results, even after adjusting for various factors such as age, sex, BMI, comorbidities, and lung function. Additionally, social determinants like education, income, air quality, and access to green spaces were identified as factors that could impact a person’s physical readiness for surgery.
The findings emphasize the importance of addressing social and environmental barriers that patients from deprived areas face when preparing for surgery. By understanding these influences, healthcare providers can design more effective and equitable preoperative pathways to support these individuals.
Dr. Shrestha emphasized the significance of considering the social and environmental factors that affect a patient’s health before surgery. Surgery poses a significant physical challenge, and patients from deprived areas often lack the resources and time to improve their health prior to an operation. By tailoring support and interventions to address these barriers, healthcare teams can ensure that all patients receive the necessary care for optimal surgical outcomes.
The research team included experts from Lancaster Medical School, Wythenshawe Hospital, the University of Manchester, Liverpool John Moores University, and East Lancashire Hospitals NHS Trust. Their collaborative efforts have provided valuable insights into the impact of social factors on patients’ fitness before surgery.
For more information, the study was published in PLOS One under the title “Exploring the association between socioeconomic status and cardiopulmonary exercise testing measures: A cohort study based on routinely collected data.” The DOI for the study is 10.1371/journal.pone.0328056.
This research highlights the importance of addressing social determinants of health in surgical care and underscores the need for tailored support for patients from deprived backgrounds. By recognizing and addressing these factors, healthcare providers can work towards achieving more equitable surgical outcomes.
