Exercise and Surgery
Patients with low cardiorespiratory health are five times more likely to die during or just after a surgical procedure than their fitter counterparts, and on average an unfit person costs the NHS an extra £6,000 when they undergo an operation, due to longer recovery times in hospital.
Studies have identified anaerobic threshold (a measure of exercise intensity performance) as the single most significant predictor – much more accurate than age alone – of complications and mortality in surgery. To tackle this issue, for the first time ever the RCSEd is launching a UK-wide education campaign to get patients moving in the run-up to surgery.
Data published in the Annals of Surgery demonstrates that post-surgical mortality can be as high as 22% in patients with low levels of fitness, whereas patients who were fitter had only a 4% mortality rate. Many studies have also found an inverse relation between cardiorespiratory health and complications in heart, lung, colorectal and bariatric surgery.
Addressing this costly and avoidable matter, the College is asking patients to speak with their surgeon or GP to work out an exercise plan that suits their condition and the type of operation they will undergo.
Consultant orthopaedic surgeon and Regional Surgical Advisor for the RCSEd, Mr Jon Dearing is leading the campaign which comprises a variety of support materials including video content and an informational leaflet. He says: “A simple 30 minutes of physical activity per day in the lead up to surgery not only can significantly reduce avoidable complications and mortality, but in some instances can even improve the chances of ‘borderline’ or unsuitable surgical candidates.
Watch an interview with Jon Dearing about exercise and surgery:
“We’re not talking necessarily about donning Lycra and getting sweaty at a gym – just straightforward measures such as walking or cycling instead of driving, taking the stairs instead of the lift and parking further away from the shops. Simple steps like this can improve surgical outcomes, aid the recovery process and even enhance the patient’s own psychological wellbeing as they get better faster. Most waiting times for surgery are around 12 weeks - this is plenty of time to work on increasing the likelihood of a successful operation."
In April this year, the Economics of Physical Inactivity Consensus (EPIC) Conference called for a globally concerted effort to improve physical activity, which could significantly reduce the length of hospital stays and use of services as well as having long term positive health economic outcomes.
Mr Dearing adds: “Many people have asked me why this is the job of surgeons. My response is that it’s a healthcare issue and as good doctors it’s what we should be doing. Undergraduates are not taught about physical activity prescription, but as consultants we are expected to have all of the answers – it only takes about 30 seconds to give advice during a consultation and those are 30 seconds that could save lives and significantly reduce costs. Millions can be saved in prescription costs alone if the fitness levels of patients were improved.”
The RCSEd is committed to promoting greater awareness among patients and consultants about the benefits of physical activity before and after surgery. Support materials to be disseminated via consultants and patient groups include a short video presented by Jon Dearing and an informational leaflet, which includes a personal story from a patient who was encouraged to exercise as part of the recovery process following a heart attack.
Resources
- Download the patient information leaflet
- Podcast - BMJ Talk Medicine
Training tomorrow's doctors in exercise medicine for tomorrow's patients
With Ann Gates and Ian Ritchie - Patient exercise sheets
Further reading
- British Journal of Sports Medicine Editorial
- Nottingham University Medical School launches ground-breaking resource for the doctors of tomorrow
- Cardiorespiratory fitness predicts mortality and hospital length of stay after major elective surgery in older people
- Effect of Cardiorespiratory Fitness on Short-Term Morbidity and Mortality After Coronary Artery Bypass Grafting
- Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions
Useful websites
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