Postoperative fatigue (POF): An underestimated complication after surgery

Abstract

Background Postoperative fatigue (POF) is a prevalent yet underestimated complication after surgery, significantly affecting patients' recovery, daily functioning, and overall quality of life. As one of the most common and distressing postoperative symptoms, POF can persist for months, placing a substantial burden patients, their immediate environment, and the healthcare system. Objective This narrative review explores the definition, incidence, and clinical significance of POF, examines underlying processes, and discusses the role of anesthetists in its management. Methods A comprehensive analysis of the literature was conducted to evaluate the incidence, clinical relevance, contributing factors, and pathophysiology of POF, its assessment methods, and potential management strategies. Results POF is a highly prevalent condition influenced by psychological, sociocultural, and biological factors. Proposed mechanisms include the inflammatory surgical stress response, perioperative muscle catabolism, psychological distress, and the influence of patient expectations. Nonetheless, the precise pathophysiological pathways remain incompletely understood and warrant further investigation. While multiple fatigue questionnaires are available, each comes with advantages and limitations. Potential strategies for reducing POF, such as prehabilitation, nutritional optimization, and tailored anesthetic techniques, show promise, but direct evidence supporting their efficacy remains limited. Conclusion Future research should focus on elucidating the underlying mechanisms of POF, developing standardized assessment tools to identify high-risk patients, simplifying postoperative follow-up as well early detection, and evaluating evidence-based strategies for prevention and management of POF. Enhancing the recognition and management of POF may improve postoperative outcomes, overall recovery, and patients' quality of life after surgery while decreasing healthcare expenses.