Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
Preoperative handgrip strength and physical activity level in association with length of stay after coronary artery bypass grafting
Arnengsih Nazir, Titing Nurhayati, Rafael AP Samudro, Reinata Digjaya, Santi Rachmaniar, Hana A Nurhalizah
Arnengsih Nazir, Department of Physical and Rehabilitation Medicine, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung 40161, West Java, Indonesia
Titing Nurhayati, Department of Emergency, RSAU Lanud Sulaiman Kopo, Bandung 40163, West Java, Indonesia
Rafael AP Samudro, Postgraduate Program, Faculty of Medicine, Universitas Padjajaran, Bandung 40163, West Java, Indonesia
Reinata Digjaya, Department of Medical, Military Hospital Type II 03.05.01 Dustira, Cimahi 40521, West Java, Indonesia
Santi Rachmaniar, Department of Emergency, RS Rama Hadi, Purwakarta 41181, West Java, Indonesia
Hana A Nurhalizah, Undergraduate Program, Faculty of Medicine Mataram University, Mataram 83121, West Nusa Tenggara, Indonesia
Author contributions: Nazir A and Samudro RAP designed the research study; Nazir A, Nurhayati T, and Samudro RAP performed the research and analyzed the data; Nazir A, Nurhayati T, Samudro RAP, Digjaya R, Rachmaniar S, and Nurhalizah HA wrote the manuscript; and all authors have read and approve the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, approval No. 203/UN6.KEP/EC/2024.
Informed consent statement: The requirement for informed consent was waived due to the retrospective design of the study and the use of fully anonymized secondary data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available. All data supporting the findings of this study are included within the article.
Corresponding author: Arnengsih Nazir, MD, MM, PhD, Academic Fellow, Assistant Pro
fessor, Department of Physical and Rehabilitation Medicine, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung 40161, West Java, Indonesia.
arnengsih@unpad.ac.id
Received: December 18, 2025
Revised: January 28, 2026
Accepted: March 9, 2026
Published online: April 26, 2026
Processing time: 116 Days and 15.7 Hours
BACKGROUND
Coronary artery bypass grafting (CABG) reduces morbidity and mortality in coronary artery disease, but postoperative complications may prolong the length of hospital stay (LoS). Previous studies have reported associations between physical activity level (PAL), handgrip strength (HGS), postoperative complications, and LoS. However, evidence directly examining the relationship between preoperative PAL or HGS and LoS remains limited, particularly in small exploratory cohorts.
AIM
To explore the potential association between preoperative PAL and HGS and postoperative LoS in patients undergoing CABG.
METHODS
This retrospective exploratory study analyzed medical records of CABG patients treated at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, between October 2023 and March 2024. Preoperative PAL was assessed using the Global Physical Activity Questionnaire, and HGS was measured in both hands. Patients with complete PAL, HGS, and LoS data were included (n = 27). Associations were analyzed using Spearman correlation for HGS and the Mann-Whitney U test for PAL, considering the limited sample size.
RESULTS
No statistically significant associations were observed between LoS and right-hand HGS (P = 0.537), left-hand HGS (P = 0.536), or total HGS (P = 0.436). PAL was also not significantly associated with LoS (P = 0.174), although patients with moderate PAL had a numerically shorter LoS.
CONCLUSION
In this study, no clear association was found between preoperative HGS or PAL and postoperative LoS following CABG. These findings should be interpreted as hypothesis-generating. Larger prospective studies are warranted.
Core Tip: Preoperative functional status has been proposed as a modifiable factor of postoperative recovery after coronary artery bypass grafting. Handgrip strength and physical activity level (PAL) are simple, low-cost measures reflecting muscle strength and functional reserve. In this article, neither preoperative handgrip strength nor PAL was significantly associated with postoperative length of hospital stay (LoS) after coronary artery bypass grafting. Although patients with moderate PAL showed a numerically shorter LoS, this finding was not statistically significant. These results highlight the multifactorial nature of postoperative LoS, predominantly driven by perioperative complications, and prospective studies integrating functional, clinical, and postoperative recovery outcomes are needed.
