Association between preoperative physical exercise and the risk of postoperative venous thromboembolism: nationwide population-based cohort study.

BACKGROUND

Although preoperative exercise is widely promoted within prehabilitation programmes, the association between habitual preoperative exercise and postoperative venous thromboembolism (VTE) remains unclear. This study examined the association between the frequency of preoperative exercise and postoperative VTE risk.

METHODS

Using the National Health Insurance Service-National Sample Cohort (2009-2016), adults who underwent surgery and preoperative health screening were identified. Exercise was classified as exerciser versus non-exerciser and by frequency (none, 1-2, or ≥3 times/week). Multivariable logistic regression adjusted for demographic, clinical, and surgical factors was used to estimate VTE risk, with subgroup analyses across demographic and lifestyle strata.

RESULTS

A total of 118 340 patients were enrolled in this study and categorized based on their exercise habits: non-exercisers (n = 33 351; 28.2%) and exercisers (n = 84 989; 71.8%). Engagement in preoperative exercise was significantly associated with a reduced risk of postoperative VTE (adjusted odds ratio [aOR]: 0.69, 95% confidence interval [c.i.]: 0.49-0.99, P = 0.041) compared to the non-exerciser group. A clear dose-response relationship was evident; while exercising 1-2 times per week was associated with a lower but non-significant risk (aOR: 0.79, 95% c.i.: 0.48-1.26, P = 0.334), the lowest and statistically significant risk was observed among patients exercising ≥3 times per week (aOR: 0.66, 95% c.i.: 0.45-0.96, P = 0.031, P for trend = 0.032). Secondary analyses confirmed similar protective trends for deep vein thrombosis, with varying degrees of risk reduction observed for other complications such as stroke. Subgroup analysis indicated that the impact of exercise on outcomes was more pronounced in male and smoking patients.

CONCLUSIONS

Preoperative exercise is an independent, modifiable factor associated with a dose-dependent reduction in VTE risk, highlighting its role as a non-pharmacological strategy to enhance surgical safety.