Assessing cardiorespiratory fitness relative to sex improves surgical risk stratification

George Rose, Richard G. Davies, Jared Torkington, Ronan M. G. Berg, Ian R. Appadurai, David C. Poole, Damian Bailey*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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To what extent sex-related differences in cardiorespiratory fitness (CRF) impact postoperative patient mortality and corresponding implications for surgical risk stratification remains to be established.

To examine this, we recruited 640 patients (366 males vs. 274 females) who underwent cardiopulmonary exercise testing prior to elective colorectal surgery. Patients were defined high risk if peak oxygen uptake was 34. Between-sex CRF and mortality was assessed, and sex-specific CRF thresholds predictive of mortality calculated.

Seventeen percent of deaths were attributed to sub-threshold CRF, which was higher than established risk factors for cardiovascular disease (CVD). The group (independent of sex) exhibited a 5-fold higher mortality (high vs. low risk patients hazard ratio =4.80, 95% confidence interval 2.73 to 8.45, P

Low CRF accounted for more deaths than traditional CVD risk factors and when CRF was considered relative to sex, the disproportionate number of females stratified unfit was corrected. These findings support clinical consideration of ‘sex-specific’ CRF thresholds to better inform postoperative mortality and improve surgical risk stratification.
Original languageEnglish
Article numbere13981
Number of pages13
JournalEuropean Journal of Clinical Investigation
Issue number7
Early online date13 Mar 2023
Publication statusPublished - 23 Mar 2023


  • Cardiorespiratory fitness
  • cardiopulmonary exercise test
  • sex
  • Colorectal surgery
  • survival


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