Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study. (March 2020)

• Record Type: Journal Article
• Authors: Wijeysundera, Duminda N.; Beattie, W. Scott; Hillis, Graham S.; Abbott, Tom E.F.; Shulman, Mark A.; Ackland, Gareth L.; Mazer, C. David; Myles, Paul S.; Pearse, Rupert M.; Cuthbertson, Brian H.; Myles, P.S.; Shulman, M.A.; Wallace, S.; Farrington, C.; Thompson, B.; Ellis, M.; Borg, B.; Kerridge, R.K.; Douglas, J.; Brannan, J.; Pretto, J.; Godsall, M.G.; Beauchamp, N.; Allen, S.; Kennedy, A.; Wright, E.; Malherbe, J.; Ismail, H.; Riedel, B.; Melville, A.; Sivakumar, H.; Murmane, A.; Kenchington, K.; Kirabiyik, Y.; Gurunathan, U.; Stonell, C.; Brunello, K.; Steele, K.; Tronstad, O.; Masel, P.; Dent, A.; Smith, E.; Bodger, A.; Abolfathi, M.; Sivalingam, P.; Hall, A.; Painter, T.W.; Macklin, S.; Elliott, A.; Carrera, A.M.; Terblanche, N.C.S.; Pitt, S.; Samuels, J.; Wilde, C.; Leslie, K.; MacCormick, A.; Bramley, D.; Southcott, A.M.; Grant, J.; Taylor, H.; Bates, S.; Towns, M.; Tippett, A.; Marshall, F.; Mazer, C.D.; Kunasingam, J.; Yagnik, A.; Crescini, C.; Yagnik, S.; McCartney, C.J.L.; Choi, S.; Somascanthan, P.; Flores, K.; Wijeysundera, D.N.; Beattie, W.S.; Karkouti, K.; Clarke, H.A.; Jerath, A.; McCluskey, S.A.; Wasowicz, M.; Granton, J.T.; Day, L.; Pazmino-Canizares, J.; Oh, P.; Belliard, R.; Lee, L.; Dobson, K.; Chan, V.; Brull, R.; Ami, N.; Stanbrook, M.; Hagen, K.; Campbell, D.; Short, T.; Van Der Westhuizen, J.; Higgie, K.; Lindsay, H.; Jang, R.; Wong, C.; Mcallister, D.; Ali, M.; Kumar, J.; Waymouth, E.; Kim, C.; Dimech, J.; Lorimer, M.; Tai, J.; Miller, R.; Sara, R.; Collingwood, A.; Olliff, S.; Gabriel, S.; Houston, H.; Dalley, P.; Hurford, S.; Hunt, A.; Andrews, L.; Navarra, L.; Jason-Smith, A.; Thompson, H.; McMillan, N.; Back, G.; Croal, B.L.; Lum, M.; Martin, D.; James, S.; Filipe, H.; Pinto, M.; Kynaston, S.; Pearse, R.M.; Abbott, T.E.F.; Phull, M.; Beilstein, C.; Bodger, P.; Everingham, K.; Hu, Y.; Niebrzegowska, E.; Corriea, C.; Creary, T.; Januszewska, M.; Ahmad, T.; Whalley, J.; Haslop, R.; McNeil, J.; Brown, A.; MacDonald, N.; Pakats, M.; Greaves, K.; Jhanji, S.; Raobaikady, R.; Black, E.; Rooms, M.; Lawrence, H.; Koutra, M.; Pirie, K.; Gertsman, M.; Jack, S.; Celinski, M.; Levett, D.; Edwards, M.; Salmon, K.; Bolger, C.; Loughney, L.; Seaward, L.; Collins, H.; Tyrell, B.; Tantony, N.; Golder, K.; Ackland, G.L.; Stephens, R.C.M.; Gallego-Paredes, L.; Reyes, A.; Gutierrez del Arroyo, A.; Raj, A.; Lifford, R.;
• Is Part Of: British journal of anaesthesia. Volume 124:Number 3(2020)
• Page Start: 261
• Page End: 270
• Publication Date: 2020-03
• Subjects: cardiopulmonary fitness -- Duke Activity Status Index -- functional capacity -- perioperative risk -- postoperative complications -- preoperative evaluation -- surgery; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1016/j.bja.2019.11.025
• Languages: English
• ISSNs: 0007-0912

Abstract

Abstract: Background: The Duke Activity Status Index (DASI) questionnaire might help incorporate self-reported functional capacity into preoperative risk assessment. Nonetheless, prognostically important thresholds in DASI scores remain unclear. We conducted a nested cohort analysis of the Measurement of Exercise Tolerance before Surgery (METS) study to characterise the association of preoperative DASI scores with postoperative death or complications. Methods: The analysis included 1546 participants (≥40 yr of age) at an elevated cardiac risk who had inpatient noncardiac surgery. The primary outcome was 30-day death or myocardial injury. The secondary outcomes were 30-day death or myocardial infarction, in-hospital moderate-to-severe complications, and 1 yr death or new disability. Multivariable logistic regression modelling was used to characterise the adjusted association of preoperative DASI scores with outcomes. Results: The DASI score had non-linear associations with outcomes. Self-reported functional capacity better than a DASI score of 34 was associated with reduced odds of 30-day death or myocardial injury (odds ratio: 0.97 per 1 point increase above 34; 95% confidence interval [CI]: 0.96–0.99) and 1 yr death or new disability (odds ratio: 0.96 per 1 point increase above 34; 95% CI: 0.92–0.99). Self-reported functional capacity worse than a DASI score of 34 was associated with increased odds of 30-day death or myocardial infarction (odds ratio: 1.05 per 1 point decrease below 34; 95% CI: 1.00–1.09), and moderate-to-severe complications (odds ratio: 1.03 per 1 point decrease below 34; 95% CI: 1.01–1.05). Conclusions: A DASI score of 34 represents a threshold for identifying patients at risk for myocardial injury, myocardial infarction, moderate-to-severe complications, and new disability.