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. 2024 Dec 5;409(1):372.
doi: 10.1007/s00423-024-03560-0.

Patient-reported questionnaires to preoperatively identify high-risk surgical patients

Renske Meijer  1   2 , David W G Ten Cate  3   4 , Bart C Bongers  5   4 , Marta Regis  6 , Hans H C M Savelberg  5 , Gerrit D Slooter  3 , Stef Janssen  7 , Martijn van Hooff  8   5 , Goof Schep  8
Affiliations

Patient-reported questionnaires to preoperatively identify high-risk surgical patients

Renske Meijer et al. Langenbecks Arch Surg. .

Abstract

Purpose: Low cardiorespiratory fitness (CRF) increases the risk of postoperative morbidity and mortality following major surgery. Assessing CRF preoperatively, by measuring peak oxygen uptake (VO2peak) during cardiopulmonary exercise testing (CPET), is valuable yet not widely available. This study aimed to assess whether questionnaires could be used preoperatively to identify high-risk surgical patients.

Methods: Healthy participants and patients who underwent CPET completed the FitMáx, Duke Activity Status Index (DASI), the modified 4-questions DASI (M-DASI-4Q), Veterans-Specific Activity Questionnaire (VSAQ), and Metabolic Equivalents of Task (MET) questionnaire. Questionnaire-VO2peak was compared with CPET-VO2peak. Overall performance of the questionnaires was assessed by the area under the curve (AUC) of receiver operating characteristic (ROC) curves. Furthermore, corresponding to the Youden index or pre-specified levels, sensitivity, specificity, and predictive values were determined.

Results: In total, 361 participants were included. All questionnaires showed high AUC values to identify high-risk patients, defined on the basis of CPET-VO2peak thresholds. FitMáx and VSAQ demonstrated superior results compared to the other questionnaires. Based on the Youden index, the optimal questionnaire-VO2peak cut-off values were 20.6, 21.3, and 26.1 ml·kg-1·min-1 for the FitMáx and 16.3, 18.2, and 20.4 ml·kg-1·min-1 for the VSAQ corresponding to the VO2peak thresholds 16.0, 18.2 and 24.5 ml·kg-1·min-1 respectively.

Conclusion: The ability to identify high-risk surgical patients preoperatively (defined by the CPET-VO2peak thresholds) by the FitMáx and the VSAQ indicates that they could be used to identify high-risk surgical patients. Patients with a poor predicted VO2peak ≤ 21.3 and ≤ 18.2 ml·kg-1·min-1, respectively for FitMáx and VSAQ, should be referred to formal preoperative (cardiopulmonary) exercise testing.

Trial registration: The study was registered as NL-OMON23304 in the Overview of Medical Research in the Netherlands, retrospectively at 28-04-2020.

Keywords: Aerobic fitness; Cardiopulmonary exercise testing; Patient-reported outcome measure; Preoperative care; Preoperative risk assessment.

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Conflict of interest statement

Declarations. Ethics approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval for this study (reference number N18.051) was provided by the authorised Medical Research Ethics Committee of the MMC, Veldhoven, the Netherlands on 30 April 2018. Informed consent for participation was obtained from all individual participants included in the study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
ROC curves for detecting predefined VO2peak thresholds with patient-reported questionnaires. Notes: AUC is reported with 95% CI. Graphs a-c: ROC curves to detect VO2peak ≤ 16.0, ≤ 18.2 and ≤ 24.5 ml·kg−1·min−1 in the total study population (n = 361). Graphs d-f: ROC curves to detect VO2peak ≤ 16.0, ≤ 18.2 and ≤ 24.5 ml·kg−1·min−1 in a subgroup with ASA I-II (n = 151). Graphs g-i: ROC curves to detect VO2peak ≤ 16.0, ≤ 18.2 and ≤ 24.5 ml·kg−1·min.−1 in a subgroup with ASA III-IV (n = 156). ° Youden index of the FitMáx. * Significant different AUC compared to the FitMáx (complete case analysis). † Significant different Youden J-statistic compared to the FitMáx (complete case analysis)
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