Preoperative Physical Fitness and Short-Term Postoperative Outcomes in Patients Undergoing Elective Cardiac Surgery: A Retrospective Cohort Study

Preoperative cardiorespiratory fitness, muscle strength, and frailty influence outcomes after cardiac surgery, but these modifiable physical factors are often not routinely incorporated into standardized risk assessments. This study examined the association between preoperative physical fitness and adverse postoperative outcomes across different elective cardiac surgery procedures. Logistic regression analyses were used to assess the association between preoperative cardiorespiratory fitness, muscle strength, functional mobility, frailty, and quality of life and delayed postoperative recovery of physical functioning (Modified Iowa Level of Assistance Scale), in-hospital complications, and postoperative atrial fibrillation in patients undergoing cardiac surgery via sternotomy, mini-thoracotomy, and transfemoral incision (transcatheter aortic valve implantation). Results showed that higher patient-reported preoperative cardiorespiratory fitness, functional mobility, frailty, and physical health-related quality of life were significantly associated with faster recovery of physical functioning and fewer postoperative complications in patients undergoing sternotomy. In patients undergoing mini-thoracotomy, preoperative cardiorespiratory fitness and functional mobility were significantly associated with in-hospital complications. No significant associations were found in patients undergoing transfemoral incision (transcatheter aortic valve implantation). Conclusively, preoperative physical fitness is associated with postoperative outcomes in patients undergoing sternotomy. These findings highlight the importance of incorporating physical fitness assessments into standard preoperative care to facilitate preoperative shared decision-making and optimize modifiable preoperative risk factors.