Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study.
Adult
Aged
Biomarkers
/ blood
Exercise Tolerance
/ physiology
Female
Health Status
Health Status Indicators
Humans
Male
Middle Aged
Myocardial Infarction
/ etiology
Natriuretic Peptide, Brain
/ blood
Peptide Fragments
/ blood
Postoperative Complications
/ mortality
Preoperative Care
/ methods
Prognosis
Prospective Studies
Risk Assessment
Risk Factors
Self Report
Surveys and Questionnaires
Duke Activity Status Index
cardiopulmonary fitness
functional capacity
perioperative risk
postoperative complications
preoperative evaluation
surgery
Journal
British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
11
09
2019
revised:
28
10
2019
accepted:
23
11
2019
pubmed:
23
12
2019
medline:
29
2
2020
entrez:
23
12
2019
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 31864719
pii: S0007-0912(19)30929-8
doi: 10.1016/j.bja.2019.11.025
pii:
doi:
Substances chimiques
Biomarkers
0
Peptide Fragments
0
pro-brain natriuretic peptide (1-76)
0
Natriuretic Peptide, Brain
114471-18-0
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
261-270Subventions
Organisme : Medical Research Council
ID : MR/M017974/1
Pays : United Kingdom
Organisme : British Heart Foundation
Pays : United Kingdom
Investigateurs
B H Cuthbertson
(BH)
D N Wijeysundera
(DN)
R M Pearse
(RM)
P S Myles
(PS)
T E F Abbott
(TEF)
M A Shulman
(MA)
B H Cuthbertson
(BH)
D N Wijeysundera
(DN)
E Torres
(E)
A Ambosta
(A)
M Melo
(M)
M Mamdani
(M)
K E Thorpe
(KE)
R M Pearse
(RM)
T E F Abbott
(TEF)
P S Myles
(PS)
M A Shulman
(MA)
S Wallace
(S)
C Farrington
(C)
B L Croal
(BL)
M P W Grocott
(MPW)
J T Granton
(JT)
P Oh
(P)
B Thompson
(B)
D Levett
(D)
G Hillis
(G)
W S Beattie
(WS)
H C Wijeysundera
(HC)
B H Cuthbertson
(BH)
D N Wijeysundera
(DN)
R M Pearse
(RM)
M A Shulman
(MA)
T E F Abbott
(TEF)
E Torres
(E)
A Ambosta
(A)
B L Croal
(BL)
J T Granton
(JT)
K E Thorpe
(KE)
M P W Grocott
(MPW)
C Farrington
(C)
S Wallace
(S)
P S Myles
(PS)
Informations de copyright
Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.