The Child Abuse Prevention and Treatment Act: Implications for Midwifery Practice and a Call to Action.

Cardiac surgery plays a crucial role in managing cardiovascular disease and significantly improves survival and quality of life. However, these complex procedures carry a substantial risk of adverse short-term postoperative outcomes. Modifiable risk factors, such as low cardiorespiratory fitness, low muscle strength, and low inspiratory muscle strength, have been associated with prolonged length of hospital stay, increased complications, and higher mortality. However, these associations are not fully understood, as studies report inconsistent findings and methodological limitations. Preoperative risk assessments for cardiac surgery, such as the Society of Thoracic Surgeons (STS) score and the European System for Cardiac Operative Risk Evaluation (EuroSCORE), are developed to estimate perioperative mortality and are also associated with postoperative complications and hospital length of stay. While valuable, these assessments primarily consider demographic and clinical variables, but often do not incorporate modifiable factors such as preoperative physical fitness. Including these modifiable factors could increase the predictive value of the preoperative assessment and may create opportunities to optimize preoperative status and improve patient- and treatment-related outcomes. Despite growing evidence supporting the role of modifiable physical fitness in preoperative risk assessment, there is no consensus on the optimal performance tests or questionnaires. Existing studies often focus on specific procedures, such as sternotomy or transfemoral aortic valve implantation (TAVI), limiting generalizability across cardiac surgery types. Moreover, prior studies frequently rely on institutionally biased outcomes, such as length of stay, rather than objective, patient-centered measures of functional recovery. This highlights the need for a broader understanding of which aspects of preoperative physical fitness influence postoperative outcomes, particularly in increasingly heterogeneous patient populations and surgical techniques. Greater insight could facilitate preoperative decision-making and provide more targeted prehabilitation interventions.