Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study

Duminda N. Wijeysundera, W. Scott Beattie, Graham S. Hillis, Tom E.F. Abbott, Mark A. Shulman, Gareth L. Ackland, C. David Mazer, Paul S. Myles, Rupert M. Pearse, Brian H. Cuthbertson, on behalf of the Measurement of Exercise Tolerance before Surgery Study Investigators

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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.

Original languageEnglish
Pages (from-to)261-270
Number of pages10
JournalBritish Journal of Anaesthesia
Volume124
Issue number3
DOIs
Publication statusPublished - Mar 2020

Keywords

  • cardiopulmonary fitness
  • Duke Activity Status Index
  • functional capacity
  • perioperative risk
  • postoperative complications
  • preoperative evaluation
  • surgery

Cite this

Wijeysundera, D. N., Beattie, W. S., Hillis, G. S., Abbott, T. E. F., Shulman, M. A., Ackland, G. L., Mazer, C. D., Myles, P. S., Pearse, R. M., Cuthbertson, B. H., & on behalf of the Measurement of Exercise Tolerance before Surgery Study Investigators (2020). Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study. British Journal of Anaesthesia, 124(3), 261-270. https://doi.org/10.1016/j.bja.2019.11.025