Postoperative Fatigue: Clinical Applications and Associated Influencing Factors
DOI:
https://doi.org/10.53469/jcmp.2025.07(02).23Keywords:
Postoperative fatigue, Influencing factors, Measurement tools, Treatment plansAbstract
Postoperative fatigue (POF) refers to a widespread and common state of fatigue experienced by patients following surgery. It is typically characterized by symptoms such as weakness, lack of concentration, low mood, and sleep disturbances. This condition not only affects the patient’s postoperative recovery but may also increase the length of hospital stays, delay functional recovery, and significantly reduce quality of life. The occurrence of postoperative fatigue is related to various factors, including the type of surgery, postoperative complications, preoperative health status, and the patient’s personal characteristics (such as psychological state and underlying health conditions). Although postoperative fatigue is widely recognized in clinical settings, its specific mechanisms remain unclear. This article reviews the definition, epidemiological features, pathophysiological mechanisms, clinical manifestations, assessment methods, and clinical management strategies of postoperative fatigue. By analyzing relevant domestic and international literature, the article aims to provide clinicians with comprehensive management approaches for postoperative fatigue and discusses future research directions.
References
Oliveira, M., et al., Surgical Oncology: Evolution of Postoperative Fatigue and Factors Related to Its Severity. Clin J Oncol Nurs, 2016. 20(1): p. E3-8.
Rubin, G.J., R. Hardy and M. Hotopf, A systematic review and meta-analysis of the incidence and severity of postoperative fatigue. J Psychosom Res, 2004. 57(3): p. 317-26.
Rose, E.A. and T.C. King, Understanding postoperative fatigue. Surgery, gynecology & obstetrics, 1978. 147(1): p. 97.
XU Xinyi, XU Qin. Postoperative fatigue: conceptual analysis [J]. Chinese Nursing Research, 2019, 33(10): 1718-1721.
Hill AG, Finn P, Schroeder D (1993) Postoperative fatigue after laparoscopic surgery. Aust N Z J Surg 63:946-951
Li H, Lockwood MB, Schlaeger JM, Liu T, Danciu OC, Doorenbos AZ. Tryptophan and Kynurenine Pathway Metabolites and Psychoneurological Symptoms Among Breast Cancer Survivors. Pain Manag Nurs. 2023 Feb; 24(1):52-59.
Rotonda C, Guillemin F, Bonnetain F, Velten M, Conroy T. Factors associated with fatigue after surgery in women with early-stage invasive breast cancer. Oncologist. 2013;18(4):467-475.
Schroeder D, Hill GL. Predicting postoperative fatigue: importance of preoperative factors. World J Surg. 1993 Mar-Apr;17(2):226-231.
Kahokehr A, Broadbent E, Wheeler BR, Sammour T, Hill AG. The effect of perioperative psychological intervention on fatigue after laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc. 2012 Jun;26(6):1730-1736.
Christensen T, Hougard F, Kehlet H (1985) Influence of pre- and intra-operative factors on the occurrence of postoperative fatigue. Br J Surg 72:63-65
Aarons H, Forester A, Hall G et al (1996) Fatigue after majorjoint arthroplasty: relationship to preoperative fatigue and post-operative emotional state. J Psychosom Res 41:225-233
Linde A. Chronisches Erschöpfungssyndrom--eine funktionelle Störung [Chronic fatigue syndrome--a functional somatic syndrome]. Ther Umsch. 2007 Oct; 64(10): 567-574. German.
Konsman JP, Parnet P, Dantzer R. Cytokine-induced sickness behaviour: mechanisms and implications. Trends Neurosci. 2002 Mar;25(3):154-159.
Cohen O, Reichenberg A, Perry C et al (2003) Endotoxin-induced changes in human working and declarative memory associate with cleavage of plasma ‘readthrough’ acetylcholinesterase. J Mol Neurosci 21:199-212.
Reichenberg A, Yirmiya R, Schuld A et al (2001) Cytokine-associated emotional and cognitive disturbances in humans. Arch Gen Psychiatry 58: 445-452.
Krabbe KS, Reichenberg A, Yirmiya R et al (2005) Low-dose endotoxemia and human neuropsychological functions. Brain BehavImmun 19:453-460.
Wright CE, Strike PC, Brydon L et al (2005) Acute inflammation and negative mood: mediation by cytokine activation. Brain Behav Immun 19:345-350.
Bower JE, et al. (2009). “Cancer-related fatigue and inflammation: A biological perspective.” Journal of Clinical Oncology, 27(26): 4433-4437.
Reichenberg A, et al. (2001). “Cytokine-associated emotional and cognitive disturbances in humans.” Archives of General Psychiatry, 58(5): 445-452.
Cordeiro LM, Guimarães JB, Wanner SP, La Guardia RB, Miranda RM, Marubayashi U, Soares DD. Inhibition of tryptophan hydroxylase abolishes fatigue induced by central tryptophan in exercising rats. Scand J Med Sci Sports. 2014 Feb;24(1):80-88.
Bower JE, Ganz PA, Aziz N. Altered cortisol response to psychologic stress in breast cancer survivors with persistent fatigue. Psychosom Med. 2005 Mar-Apr; 67(2): 277-80.
McGuire J, Ross GL, Price H et al (2003) Biochemical markers for post-operative fatigue after major surgery. Brain Res Bull 60:125-130.
Zhao X, Wang T, Sheng G, Tang Y, Shen M, Yang J. The fatigue, sleep and physical activity in postoperative patients with pituitary adenoma: what we can do. Transl Cancer Res. 2020 Mar;9(3):1779-1786.
Rubin GJ, Hotopf M (2002) Systematic review and meta-analysis of interventions for postoperative fatigue. Br J Surg 89:971-984.
Kissmeyer-Nielsen P, Jensen MB, Laurberg S (1999) Periopera-tive growth hormone treatment and functional outcome after major abdominal surgery: a randomized, double-blind, controlled study. Ann Surg 229:298-302.
.Ammitzbøll G, Kristina Kjær T, Johansen C, Lanng C, Wreford Andersen E, Kroman N, Zerahn B, Hyldegaard O, Envold Bidstrup P, Oksbjerg Dalton S. Effect of progressive resistance training on health-related quality of life in the first year after breast cancer surgery - results from a randomized controlled trial. Acta Oncol. 2019 May;58(5):665-672.
Aarons H, Aarons H, Forester A, Hall G, Salmon P. Fatigue after major joint arthroplasty: relationship to preoperative fatigue and postoperative emotional state. J Psychosom Res. 1996 Sep;41(3):225-233.
Rao L, Liu X, Yu L, Xiao H. Effect of nursing intervention to guide early postoperative activities on rapid rehabilitation of patients undergoing abdominal surgery: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2021 Mar 26; 100(12):e24776.
Howe L, Husband A, Robinson-Barella A. Prescribing pre- and post-operative physical activity interventions for people undergoing breast cancer surgery: A qualitative systematic review. Cancer Med. 2024 Feb; 13(4):e7063.
Krupp LB, Alvarez LA, LaRocca NG et al (1988) Fatigue in multiple sclerosis. Arch Neurol 45:435-437.
Lauszus, F.F., E. Kallfa and M.R. Madsen, Fatigue and physical function after hysterectomy measured by SF-36, ergometer, and dynamometer. Arch Gynecol Obstet, 2016. 294(1): p. 95-101.
Yu, J., et al., Risk factors for postoperative fatigue after gastrointestinal surgery. J Surg Res, 2015. 194(1): p. 114-119.
Chi Songlin, Wenjuan. The Preliminary Revision of Brief Profile of Mood States (BPOMS) -Chinese Edition [J]. Chinese Mental Health Journal, 2003, 17(11): 768-770+767.
Jaffery, A., M.K. Edwards and P.D. Loprinzi, Randomized Control Intervention Evaluating the Effects of Acute Exercise on Depression and Mood Profile: Solomon Experimental Design. Mayo Clin Proc, 2017. 92(3): p. 480-481.
Nostdahl, T., et al., Postoperative fatigue; translation and validation of a revised 10-item short form of the Identity-Consequence Fatigue Scale (ICFS). J Psychosom Res, 2016. 84: p. 1-7.
Aagaard L, Hansen EH. Information about ADRs explored by pharmacovigilance approaches: a qualitative review of studies on antibiotics, SSRIs and NSAIDs. BMC Clin Pharmacol. 2009 Mar 3;9:4.
Breitbart W, Alici-Evcimen Y. Update on psychotropic medications for cancer-related fatigue. J Natl Compr Canc Netw. 2007 Nov;5(10):1081-1091.
Murphy JD, Yan D, Hanna MN, Bravos ED, Isaac GR, Eng CA, Wu CL. Comparison of the postoperative analgesic efficacy of intravenous patient-controlled analgesia with tramadol to intravenous patient-controlled analgesia with opioids. J Opioid Manag. 2010 Mar-Apr;6(2):141-147.
Kamath J. Cancer-related fatigue, inflammation and thyrotropin-releasing hormone. Curr Aging Sci. 2012 Dec; 5(3):195-202.
da Costa Torres D, Dos Santos PM, Reis HJ, Paisani DM, Chiavegato LD. Effectiveness of an early mobilization program on functional capacity after coronary artery bypass surgery: A randomized controlled trial protocol. SAGE Open Med. 2016 Dec 14;4:2050312116682256.
Abdollahi L, Mirghafourvand M, Babapour JK, Mohammadi M. Effectiveness of cognitive-behavioral therapy (CBT) in improving the quality of life and psychological fatigue in women with polycystic ovarian syndrome: a randomized controlled clinical trial. J Psychosom Obstet Gynaecol. 2019 Dec;40(4):283-293.
Gögenur I, Ocak U, Altunpinar O, Middleton B, Skene DJ, Rosenberg J. Disturbances in melatonin, cortisol and core body temperature rhythms after major surgery. World J Surg. 2007 Feb;31(2):290-298.
Adamson J, Ali S, Santhouse A, Wessely S, Chalder T. Cognitive behavioural therapy for chronic fatigue and chronic fatigue syndrome: outcomes from a specialist clinic in the UK. J R Soc Med. 2020 Oct; 113(10): 394-402.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Runjie Guo, Shile Wu, Wei Gao, Wenjun Zhu
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
