Perioperative medicine & outcomes
Metabolic Flexibility as a Candidate Mechanism for the Development of Postoperative Morbidity
Authors' conclusion
Metabolic flexibility may be a pivotal factor in determining postoperative outcomes. Patients with greater metabolic adaptability had fewer complications and shorter hospitalization by 4 days on average.
Study context
- Population
- Patients undergoing a range of major surgeries with preoperative cardiopulmonary exercise testing (CPET), 2012–2022
- Participants
- 585 patients
- Exposure
- Metabolic flexibility across Postoperative Morbidity Survey (POMS) day 3 categories 0-1, 2 and 3-6
- Outcome
- Fat oxidation early in exercise before anaerobic threshold (FATox AUC)
Methodological detailsprospectively collected database, single-centre
- Prospectively collected database
- Single-centre
Main finding
As reported in the abstract
POMS 0-1
826
range 578–1147
POMS 2
658
range 448–922
POMS 3 to 6
608
range 414–845
POMS 2 vs POMS 0-1: P < 0.001 · POMS 3 to 6 vs POMS 0-1: P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | POMS 0-1 | POMS 2 | POMS 3 to 6 | P value |
|---|---|---|---|---|
| Carbohydrate oxidation (CHOox AUC)POMS 2 vs POMS 0-1 | 10277 (IQR 7773–13358) | 8356 (IQR 6548–10377) | 6696 (IQR 473–9392) | P < 0.001 |
| Carbohydrate oxidation (CHOox AUC)POMS 3 to 6 vs POMS 0-1 | P < 0.001 |
Carbohydrate oxidation (CHOox AUC)
- POMS 0 to 1 patients had more effective carbohydrate utilization at peak exercise intensity
Postoperative complications and hospital LOS
- Reduced metabolic flexibility correlated with increased postoperative complications and an extended hospital stay
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Metabolic Flexibility as a Candidate Mechanism for the Development of Postoperative Morbidity. Anesth Analg. Published 2 April 2025. doi:10.
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