The role of perioperatively acquired muscle weakness in postoperative fatigue: A narrative review

Postoperative fatigue (POF) and perioperatively acquired muscle weakness (POAW) are significant yet often under-recognised interlinked postoperative complications that can significantly hinder postoperative recovery and diminish overall quality of life after surgery. Despite advancements in surgical and anaesthetic techniques and the widespread implementation of Enhanced Recovery After Surgery (ERAS) protocols, these conditions remain prevalent. In the weeks following surgery, reported incidences of fatigue of any severity range from 10% to as high as 90%, depending on the patient population. Particularly affecting high-risk patients and those undergoing major surgery, POF and POAW are frequently overlooked in clinical practice. This narrative review explores the biological mechanisms underlying these conditions, highlighting key factors that contribute to their development. It also explores the interrelationship between POAW and the development of POF. While some promising strategies exist, effective and targeted interventions to reduce POF and POAW remain limited. A comprehensive understanding of these postoperative complications is crucial to guide future research and the development of evidence-based management strategies. Ultimately, addressing POF and POAW holds the potential to enhance recovery after surgery, improve long-term outcomes, and reduce the overall healthcare burden associated with surgical procedures.