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

Publication ,  Journal Article
Wijeysundera, DN; Beattie, WS; Hillis, GS; Abbott, TEF; Shulman, MA; Ackland, GL; Mazer, CD; Myles, PS; Pearse, RM; Cuthbertson, BH; Myles, PS ...
Published in: Br J Anaesth
March 2020

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.

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Published In

Br J Anaesth

DOI

EISSN

1471-6771

Publication Date

March 2020

Volume

124

Issue

3

Start / End Page

261 / 270

Location

England

Related Subject Headings

  • Surveys and Questionnaires
  • Self Report
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • Prognosis
  • Preoperative Care
  • Postoperative Complications
  • Peptide Fragments
  • Natriuretic Peptide, Brain
 

Citation

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Wijeysundera, D. N., Beattie, W. S., Hillis, G. S., Abbott, T. E. F., Shulman, M. A., Ackland, G. L., … International Steering Committee. (2020). Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study. Br J Anaesth, 124(3), 261–270. https://doi.org/10.1016/j.bja.2019.11.025
Wijeysundera, Duminda N., W Scott Beattie, Graham S. Hillis, Tom E. F. Abbott, Mark A. Shulman, Gareth L. Ackland, C David Mazer, et al. “Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study.Br J Anaesth 124, no. 3 (March 2020): 261–70. https://doi.org/10.1016/j.bja.2019.11.025.
Wijeysundera DN, Beattie WS, Hillis GS, Abbott TEF, Shulman MA, Ackland GL, et al. Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study. Br J Anaesth. 2020 Mar;124(3):261–70.
Wijeysundera, Duminda N., et al. “Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study.Br J Anaesth, vol. 124, no. 3, Mar. 2020, pp. 261–70. Pubmed, doi:10.1016/j.bja.2019.11.025.
Wijeysundera DN, Beattie WS, Hillis GS, Abbott TEF, Shulman MA, Ackland GL, Mazer CD, Myles PS, Pearse RM, Cuthbertson BH, Measurement of Exercise Tolerance before Surgery Study Investigators, Wallace S, Farrington C, Thompson B, Ellis M, Borg B, Kerridge RK, Douglas J, Brannan J, Pretto J, Godsall MG, 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 TW, Macklin S, Elliott A, Carrera AM, Terblanche NCS, Pitt S, Samuels J, Wilde C, Leslie K, MacCormick A, Bramley D, Southcott AM, Grant J, Taylor H, Bates S, Towns M, Tippett A, Marshall F, Kunasingam J, Yagnik A, Crescini C, Yagnik S, McCartney CJL, Choi S, Somascanthan P, Flores K, Karkouti K, Clarke HA, Jerath A, McCluskey SA, Wasowicz M, Granton JT, 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 BL, Lum M, Martin D, James S, Filipe H, Pinto M, Kynaston S, 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, Stephens RCM, Gallego-Paredes L, Reyes A, Gutierrez Del Arroyo A, Raj A, Lifford R, International and National Coordinators, Central Project Office Operations Committee, CPET Methods Committee, Outcome Adjudication Committee, International Steering Committee. Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study. Br J Anaesth. 2020 Mar;124(3):261–270.
Journal cover image

Published In

Br J Anaesth

DOI

EISSN

1471-6771

Publication Date

March 2020

Volume

124

Issue

3

Start / End Page

261 / 270

Location

England

Related Subject Headings

  • Surveys and Questionnaires
  • Self Report
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • Prognosis
  • Preoperative Care
  • Postoperative Complications
  • Peptide Fragments
  • Natriuretic Peptide, Brain