The effect of the COVID-19 pandemic on the functional capacity and cardiopulmonary fitness of major surgery patients.


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Miranda Bowman1, Rhona Sinclair2, Alastair Greystoke1
1Newcastle University, 2Newcastle upon Tyne Hospitals NHS Foundation Trust

Abstract

Background

International surveys have found confinement due to the COVID-19 pandemic results in reduced physical activity in the population. There is no evidence of a reduction in functional capacity (FC) or cardiopulmonary fitness (CPF). This study aimed to compare FC and CPF before and during the pandemic, and assess the influence of social deprivation, in cancer patients.

Method

FC scores and cardiopulmonary exercise testing (CPET) results from all major surgery patients (75% were cancer operations) who attended a high-risk preoperative assessment clinic in Newcastle-upon-Tyne between 1/12/2019 and 31/1/2020 (pre-pandemic, group 1) were compared with patients who attended the same clinic between 1/2/2021 and 31/3/21 (during 3rd UK lockdown, group 2). FC was assessed at nurse consultation, recorded as free text, and categorized by the researcher according to commonly mentioned capabilities. Oxygen uptake at anaerobic threshold (AT) and peak oxygen uptake (VO2 peak) were reported by a consultant anaesthetist after CPET. Patients’ postcodes were used to ascertain Townsend Deprivation scores (TDS) and quintiles of social deprivation relative to UK population.

Results

93 patients were in group 1 and 102 in group 2. There were significantly more patients in the highest-performing FC category in group 1 compared to group 2 (75% vs 52% respectively; p=0.001). Mean AT decreased from 14.7 ± 0.46 ml/kg/min in group 1 to 12.8 ± 0.39 ml/kg/min in group 2 (difference: 1.9; p=0.002). Mean VO2 peak decreased from 19.0 ± 0.63 ml/kg/min in group 1 to 17.1 ± 0.59 ml/kg/min in group 2 (difference: 1.9; p=0.027).

 

A Mixed-Effect Model suggested a significant interaction between the impact of the pandemic and social deprivation on VO2 peak; p=0.0406. There was no difference in the least deprived quintiles, 1 and 2, (mean difference 0.47 ± 1.4; p=0.74) but a significant difference in quintiles 3-5 (mean difference -3.8 ± 1.2; p=0.014).

Conclusion

This study found a reduction in subjective FC and objectively measured CPF in major surgery patients since the COVID-19 pandemic. Reduced CPF was worse in deprived areas. This may impact complication rate and length of hospital stay of cancer patients following surgery.

Impact statement

The COVID-19 pandemic has worsened the fitness of cancer surgery patients.