The study was led by PhD researcher Dr Donna Shrestha from Lancaster Medical School, where her research focuses on health inequalities in the surgical patient pathway. She is also a senior resident doctor with a specialist interest in colorectal surgery.
The research published in PLOS ONE suggests that patients from more socioeconomically deprived areas may have lower cardiorespiratory fitness at the time of preoperative assessment.
Dr Shrestha said: “The study reveals a clear social gradient in physical resilience before surgery. This difference in fitness could help explain why patients from deprived areas often have poorer surgical outcomes. Cardiorespiratory fitness is one of the few modifiable risk factors before an operation. Identifying patients who might benefit most from early intervention and ensuring they get that support is vital if we want fairer surgical outcomes.”
The researchers analysed data from over 3,300 patients at a large NHS hospital who underwent Cardiopulmonary exercise testing (CPET). CPET provides objective, effort-based measures of cardiorespiratory fitness, which can help clinicians assess surgical risk, guide prehabilitation efforts, and tailor perioperative care.
Patients from more deprived backgrounds were younger, had higher BMIs, and were more likely to smoke or have multiple comorbidities than those from less deprived areas.
The findings suggest that social and environmental factors—like income, education, air quality, and access to green space—can have small but significant impact on a person’s physical readiness for surgery. Understanding these influences helps the NHS and care teams tailor support for patients more effectively.
Dr Shrestha said: “Surgery is a major physical challenge. Patients from deprived areas often have less time and fewer resources to improve their health before an operation. By understanding the social and environmental barriers they face, we can design preoperative pathways that are not just clinically effective, but equitable.”
The research was funded by Collaboration North West Coast (NIHR ARC NWC).
PLOS One
Experimental study
People
Exploring the association between socioeconomic status and cardiopulmonary exercise testing measures
12-Aug-2025