Abstract
The comments of Dr. Shahar et al. are interesting. Our literature search, like theirs, did not find any studies focusing on postoperative deconditioning caused by bedrest. Despite this paucity of literature, it seems to be commonly accepted that prolonged immobilization is detrimental to recovery. Preoperative functional status, measured in terms of activities of daily living or more global measures, is a predictor of poor postoperative outcomes. Several studies reporting this association are referenced in our paper. Dr. Shahar suggests that we should predict postoperative functional decline preoperatively. Would that we could. No validated instrument or set of risk factors currently exist to do so. The issue of postoperative deconditioning deserves further study, and we encourage his group to pursue this.
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