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

Duminda N Wijeysundera¹, W Scott Beattie², Graham S Hillis³, Tom E F Abbott⁴, Mark A Shulman⁵, Gareth L Ackland⁴, C David Mazer⁶, Paul S Myles⁵, Rupert M Pearse⁷, Brian H Cuthbertson⁸; Measurement of Exercise Tolerance before Surgery Study Investigators; P S Myles⁹, M A Shulman⁹, S Wallace⁹, C Farrington⁹, B Thompson⁹, M Ellis⁹, B Borg⁹, R K Kerridge¹⁰, J Douglas¹⁰, J Brannan¹⁰, J Pretto¹⁰, M G Godsall¹¹, N Beauchamp¹¹, S Allen¹¹, A Kennedy¹¹, E Wright¹¹, J Malherbe¹¹, H Ismail¹², B Riedel¹², A Melville¹², H Sivakumar¹², A Murmane¹², K Kenchington¹², Y Kirabiyik¹², U Gurunathan¹³, C Stonell¹³, K Brunello¹³, K Steele¹³, O Tronstad¹³, P Masel¹³, A Dent¹³, E Smith¹³, A Bodger¹³, M Abolfathi¹³, P Sivalingam¹⁴, A Hall¹⁴, T W Painter¹⁵, S Macklin¹⁵, A Elliott¹⁵, A M Carrera¹⁵, N C S Terblanche¹⁶, S Pitt¹⁶, J Samuels¹⁶, C Wilde¹⁶, K Leslie¹⁷, A MacCormick¹⁷, D Bramley¹⁸, A M Southcott¹⁸, J Grant¹⁸, H Taylor¹⁸, S Bates¹⁸, M Towns¹⁸, A Tippett¹⁸, F Marshall¹⁸, C D Mazer¹⁹, J Kunasingam¹⁹, A Yagnik¹⁹, C Crescini¹⁹, S Yagnik¹⁹, C J L McCartney²⁰, S Choi²⁰, P Somascanthan²⁰, K Flores²⁰, D N Wijeysundera²¹, W S Beattie²¹, K Karkouti²¹, H A Clarke²¹, A Jerath²¹, S A McCluskey²¹, M Wasowicz²¹, J T Granton²¹, L Day²¹, J Pazmino-Canizares²¹, P Oh²², R Belliard²², L Lee²², K Dobson²², V Chan²³, R Brull²³, N Ami²³, M Stanbrook²³, K Hagen²⁴, D Campbell²⁴, T Short²⁴, J Van Der Westhuizen²⁴, K Higgie²⁴, H Lindsay²⁴, R Jang²⁴, C Wong²⁴, D Mcallister²⁴, M Ali²⁴, J Kumar²⁴, E Waymouth²⁴, C Kim²⁴, J Dimech²⁵, M Lorimer²⁵, J Tai²⁵, R Miller²⁵, R Sara²⁵, A Collingwood²⁵, S Olliff²⁵, S Gabriel²⁵, H Houston²⁵, P Dalley²⁶, S Hurford²⁶, A Hunt²⁶, L Andrews²⁶, L Navarra²⁶, A Jason-Smith²⁶, H Thompson²⁶, N McMillan²⁶, G Back²⁶, B L Croal²⁷, M Lum²⁷, D Martin²⁸, S James²⁸, H Filipe²⁸, M Pinto²⁸, S Kynaston²⁸, R M Pearse²⁹, T E F Abbott²⁹, M Phull²⁹, C Beilstein²⁹, P Bodger²⁹, K Everingham²⁹, Y Hu²⁹, E Niebrzegowska²⁹, C Corriea²⁹, T Creary²⁹, M Januszewska²⁹, T Ahmad²⁹, J Whalley²⁹, R Haslop²⁹, J McNeil²⁹, A Brown²⁹, N MacDonald²⁹, M Pakats²⁹, K Greaves²⁹, S Jhanji³⁰, R Raobaikady³⁰, E Black³⁰, M Rooms³⁰, H Lawrence³⁰, M Koutra³⁰, K Pirie³⁰, M Gertsman³⁰, S Jack³¹, M Celinski³¹, D Levett³¹, M Edwards³¹, K Salmon³¹, C Bolger³¹, L Loughney³¹, L Seaward³¹, H Collins³¹, B Tyrell³¹, N Tantony³¹, K Golder³¹, G L Ackland³², R C M Stephens³², L Gallego-Paredes³², A Reyes³², A Gutierrez Del Arroyo³², A Raj³³, R Lifford³³; International and National Coordinators; Central Project Office Operations Committee; CPET Methods Committee; Outcome Adjudication Committee; International Steering Committee

Collaborators, Affiliations

Affiliations

¹ Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada. Electronic address: d.wijeysundera@utoronto.ca.
² Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.
³ Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia; Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.
⁴ The William Harvey Research Institute, Queen Mary University of London, London, UK; Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
⁵ Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital and Monash University, Melbourne, VIC, Australia; Department of Anaesthesiology and Perioperative Medicine, Monash University, Melbourne, VIC, Australia.
⁶ Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
⁷ Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
⁸ Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁹ Alfred Hospital, Australia.
¹⁰ John Hunter Hospital, Australia.
¹¹ Nambour General Hospital, Australia.
¹² Peter McCallum Cancer Centre, Australia.
¹³ Prince Charles Hospital, Australia.
¹⁴ Princess Alexandra Hospital, Australia.
¹⁵ Royal Adelaide Hospital, Australia.
¹⁶ Royal Hobart Hospital, Australia.
¹⁷ Royal Melbourne Hospital, Australia.
¹⁸ Western Health, Australia.
¹⁹ St Michael's Hospital, Canada.
²⁰ Sunnybrook Health Sciences Centre, Canada.
²¹ Toronto General Hospital, Canada.
²² Toronto Rehabilitation Institute - Rumsey Centre, Canada.
²³ Toronto Western Hospital, Canada.
²⁴ Auckland City Hospital, New Zealand.
²⁵ Middlemore Hospital, New Zealand.
²⁶ Wellington Hospital, New Zealand.
²⁷ Aberdeen Royal Infirmary, United Kingdom.
²⁸ Royal Free Hospital, United Kingdom.
²⁹ Royal London Hospital, United Kingdom.
³⁰ Royal Marsden Hospital, United Kingdom.
³¹ Southampton General Hospital, United Kingdom.
³² University College London Hospital, United Kingdom.
³³ Whipps Cross Hospital, United Kingdom.

PMID: 31864719
DOI: 10.1016/j.bja.2019.11.025

Free article

Multicenter Study

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

Duminda N Wijeysundera et al. Br J Anaesth. 2020 Mar.

Free article

. 2020 Mar;124(3):261-270.

doi: 10.1016/j.bja.2019.11.025. Epub 2019 Dec 19.

Authors

Affiliations

¹ Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada. Electronic address: d.wijeysundera@utoronto.ca.
² Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.
³ Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia; Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.
⁴ The William Harvey Research Institute, Queen Mary University of London, London, UK; Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
⁵ Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital and Monash University, Melbourne, VIC, Australia; Department of Anaesthesiology and Perioperative Medicine, Monash University, Melbourne, VIC, Australia.
⁶ Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
⁷ Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
⁸ Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁹ Alfred Hospital, Australia.
¹⁰ John Hunter Hospital, Australia.
¹¹ Nambour General Hospital, Australia.
¹² Peter McCallum Cancer Centre, Australia.
¹³ Prince Charles Hospital, Australia.
¹⁴ Princess Alexandra Hospital, Australia.
¹⁵ Royal Adelaide Hospital, Australia.
¹⁶ Royal Hobart Hospital, Australia.
¹⁷ Royal Melbourne Hospital, Australia.
¹⁸ Western Health, Australia.
¹⁹ St Michael's Hospital, Canada.
²⁰ Sunnybrook Health Sciences Centre, Canada.
²¹ Toronto General Hospital, Canada.
²² Toronto Rehabilitation Institute - Rumsey Centre, Canada.
²³ Toronto Western Hospital, Canada.
²⁴ Auckland City Hospital, New Zealand.
²⁵ Middlemore Hospital, New Zealand.
²⁶ Wellington Hospital, New Zealand.
²⁷ Aberdeen Royal Infirmary, United Kingdom.
²⁸ Royal Free Hospital, United Kingdom.
²⁹ Royal London Hospital, United Kingdom.
³⁰ Royal Marsden Hospital, United Kingdom.
³¹ Southampton General Hospital, United Kingdom.
³² University College London Hospital, United Kingdom.
³³ Whipps Cross Hospital, United Kingdom.

PMID: 31864719
DOI: 10.1016/j.bja.2019.11.025

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.

Keywords: Duke Activity Status Index; cardiopulmonary fitness; functional capacity; perioperative risk; postoperative complications; preoperative evaluation; surgery.

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

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

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