Postoperative changes in fatigue, physical function, and body composition: an analysis of the amalgamated data from five randomised trials on patients undergoing colorectal surgery

Abstract Aims: Changes in postoperative fatigue, physical function, and body composition were described in patients after open colorectal surgery and factors that predicted postoperative fatigue one month after surgery were identified. Methods: Data from five clinical intervention studies from 1991-2005 were amalgamated. Patients (n=385) were examined preoperatively, at discharge, and one month postoperatively. The level of fatigue was scored subjectively from 1 "fit" to 10 "fatigued" on a modified visual analogue scale and by objective measurements of hand grip and knee extension strength, work capacity, weight, lean body mass, and fat mass. A logistic regression analysis was used to identify the predictors of a high fatigue score one month postoperatively. Results: Preoperatively, only 17% had a high fatigue score (>/=5.5), whereas 65% and 30% had a high fatigue score at discharge and one month postoperatively, respectively. Postoperatively there was a significant fall in physical performance, weight, lean body mass, and fat mass that did not normalise by one month. High preoperative and discharge fatigue scores, major complications, and the loss of lean body mass increased significantly the risk of fatigue one month postoperatively. Conclusion: Open colorectal surgery was associated with a significant increase in postoperative fatigue and a decline in physical performance, weight, and lean body mass. Major complications, a high perioperative fatigue score, and the loss of lean body mass increased the risk of long-term fatigue.