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Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study.
British Journal of Anaesthesia ( IF 9.1 ) Pub Date : 2019-12-19 , DOI: 10.1016/j.bja.2019.11.025 Duminda N Wijeysundera 1 , W Scott Beattie 2 , Graham S Hillis 3 , Tom E F Abbott 4 , Mark A Shulman 5 , Gareth L Ackland 4 , C David Mazer 6 , Paul S Myles 5 , Rupert M Pearse 7 , Brian H Cuthbertson 8 , , P S Myles 9 , M A Shulman 9 , S Wallace 9 , C Farrington 9 , B Thompson 9 , M Ellis 9 , B Borg 9 , R K Kerridge 10 , J Douglas 10 , J Brannan 10 , J Pretto 10 , M G Godsall 11 , N Beauchamp 11 , S Allen 11 , A Kennedy 11 , E Wright 11 , J Malherbe 11 , H Ismail 12 , B Riedel 12 , A Melville 12 , H Sivakumar 12 , A Murmane 12 , K Kenchington 12 , Y Kirabiyik 12 , U Gurunathan 13 , C Stonell 13 , K Brunello 13 , K Steele 13 , O Tronstad 13 , P Masel 13 , A Dent 13 , E Smith 13 , A Bodger 13 , M Abolfathi 13 , P Sivalingam 14 , A Hall 14 , T W Painter 15 , S Macklin 15 , A Elliott 15 , A M Carrera 15 , N C S Terblanche 16 , S Pitt 16 , J Samuels 16 , C Wilde 16 , K Leslie 17 , A MacCormick 17 , D Bramley 18 , A M Southcott 18 , J Grant 18 , H Taylor 18 , S Bates 18 , M Towns 18 , A Tippett 18 , F Marshall 18 , C D Mazer 19 , J Kunasingam 19 , A Yagnik 19 , C Crescini 19 , S Yagnik 19 , C J L McCartney 20 , S Choi 20 , P Somascanthan 20 , K Flores 20 , D N Wijeysundera 21 , W S Beattie 21 , K Karkouti 21 , H A Clarke 21 , A Jerath 21 , S A McCluskey 21 , M Wasowicz 21 , J T Granton 21 , L Day 21 , J Pazmino-Canizares 21 , P Oh 22 , R Belliard 22 , L Lee 22 , K Dobson 22 , V Chan 23 , R Brull 23 , N Ami 23 , M Stanbrook 23 , K Hagen 24 , D Campbell 24 , T Short 24 , J Van Der Westhuizen 24 , K Higgie 24 , H Lindsay 24 , R Jang 24 , C Wong 24 , D Mcallister 24 , M Ali 24 , J Kumar 24 , E Waymouth 24 , C Kim 24 , J Dimech 25 , M Lorimer 25 , J Tai 25 , R Miller 25 , R Sara 25 , A Collingwood 25 , S Olliff 25 , S Gabriel 25 , H Houston 25 , P Dalley 26 , S Hurford 26 , A Hunt 26 , L Andrews 26 , L Navarra 26 , A Jason-Smith 26 , H Thompson 26 , N McMillan 26 , G Back 26 , B L Croal 27 , M Lum 27 , D Martin 28 , S James 28 , H Filipe 28 , M Pinto 28 , S Kynaston 28 , R M Pearse 29 , T E F Abbott 29 , M Phull 29 , C Beilstein 29 , P Bodger 29 , K Everingham 29 , Y Hu 29 , E Niebrzegowska 29 , C Corriea 29 , T Creary 29 , M Januszewska 29 , T Ahmad 29 , J Whalley 29 , R Haslop 29 , J McNeil 29 , A Brown 29 , N MacDonald 29 , M Pakats 29 , K Greaves 29 , S Jhanji 30 , R Raobaikady 30 , E Black 30 , M Rooms 30 , H Lawrence 30 , M Koutra 30 , K Pirie 30 , M Gertsman 30 , S Jack 31 , M Celinski 31 , D Levett 31 , M Edwards 31 , K Salmon 31 , C Bolger 31 , L Loughney 31 , L Seaward 31 , H Collins 31 , B Tyrell 31 , N Tantony 31 , K Golder 31 , G L Ackland 32 , R C M Stephens 32 , L Gallego-Paredes 32 , A Reyes 32 , A Gutierrez Del Arroyo 32 , A Raj 33 , R Lifford 33 , , , , ,
British Journal of Anaesthesia ( IF 9.1 ) Pub Date : 2019-12-19 , DOI: 10.1016/j.bja.2019.11.025 Duminda N Wijeysundera 1 , W Scott Beattie 2 , Graham S Hillis 3 , Tom E F Abbott 4 , Mark A Shulman 5 , Gareth L Ackland 4 , C David Mazer 6 , Paul S Myles 5 , Rupert M Pearse 7 , Brian H Cuthbertson 8 , , P S Myles 9 , M A Shulman 9 , S Wallace 9 , C Farrington 9 , B Thompson 9 , M Ellis 9 , B Borg 9 , R K Kerridge 10 , J Douglas 10 , J Brannan 10 , J Pretto 10 , M G Godsall 11 , N Beauchamp 11 , S Allen 11 , A Kennedy 11 , E Wright 11 , J Malherbe 11 , H Ismail 12 , B Riedel 12 , A Melville 12 , H Sivakumar 12 , A Murmane 12 , K Kenchington 12 , Y Kirabiyik 12 , U Gurunathan 13 , C Stonell 13 , K Brunello 13 , K Steele 13 , O Tronstad 13 , P Masel 13 , A Dent 13 , E Smith 13 , A Bodger 13 , M Abolfathi 13 , P Sivalingam 14 , A Hall 14 , T W Painter 15 , S Macklin 15 , A Elliott 15 , A M Carrera 15 , N C S Terblanche 16 , S Pitt 16 , J Samuels 16 , C Wilde 16 , K Leslie 17 , A MacCormick 17 , D Bramley 18 , A M Southcott 18 , J Grant 18 , H Taylor 18 , S Bates 18 , M Towns 18 , A Tippett 18 , F Marshall 18 , C D Mazer 19 , J Kunasingam 19 , A Yagnik 19 , C Crescini 19 , S Yagnik 19 , C J L McCartney 20 , S Choi 20 , P Somascanthan 20 , K Flores 20 , D N Wijeysundera 21 , W S Beattie 21 , K Karkouti 21 , H A Clarke 21 , A Jerath 21 , S A McCluskey 21 , M Wasowicz 21 , J T Granton 21 , L Day 21 , J Pazmino-Canizares 21 , P Oh 22 , R Belliard 22 , L Lee 22 , K Dobson 22 , V Chan 23 , R Brull 23 , N Ami 23 , M Stanbrook 23 , K Hagen 24 , D Campbell 24 , T Short 24 , J Van Der Westhuizen 24 , K Higgie 24 , H Lindsay 24 , R Jang 24 , C Wong 24 , D Mcallister 24 , M Ali 24 , J Kumar 24 , E Waymouth 24 , C Kim 24 , J Dimech 25 , M Lorimer 25 , J Tai 25 , R Miller 25 , R Sara 25 , A Collingwood 25 , S Olliff 25 , S Gabriel 25 , H Houston 25 , P Dalley 26 , S Hurford 26 , A Hunt 26 , L Andrews 26 , L Navarra 26 , A Jason-Smith 26 , H Thompson 26 , N McMillan 26 , G Back 26 , B L Croal 27 , M Lum 27 , D Martin 28 , S James 28 , H Filipe 28 , M Pinto 28 , S Kynaston 28 , R M Pearse 29 , T E F Abbott 29 , M Phull 29 , C Beilstein 29 , P Bodger 29 , K Everingham 29 , Y Hu 29 , E Niebrzegowska 29 , C Corriea 29 , T Creary 29 , M Januszewska 29 , T Ahmad 29 , J Whalley 29 , R Haslop 29 , J McNeil 29 , A Brown 29 , N MacDonald 29 , M Pakats 29 , K Greaves 29 , S Jhanji 30 , R Raobaikady 30 , E Black 30 , M Rooms 30 , H Lawrence 30 , M Koutra 30 , K Pirie 30 , M Gertsman 30 , S Jack 31 , M Celinski 31 , D Levett 31 , M Edwards 31 , K Salmon 31 , C Bolger 31 , L Loughney 31 , L Seaward 31 , H Collins 31 , B Tyrell 31 , N Tantony 31 , K Golder 31 , G L Ackland 32 , R C M Stephens 32 , L Gallego-Paredes 32 , A Reyes 32 , A Gutierrez Del Arroyo 32 , A Raj 33 , R Lifford 33 , , , , ,
Affiliation
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.
中文翻译：
将杜克活动状态指数纳入术前风险评估：一项多中心前瞻性队列研究。
背景技术杜克活动状态指数（DASI）调查表可能有助于将自我报告的功能能力纳入术前风险评估。尽管如此，DASI评分的预后重要阈值仍不清楚。我们对手术前运动耐力测量（METS）研究进行了嵌套队列研究，以表征术前DASI评分与术后死亡或并发症的相关性。方法该分析纳入了1546名年龄≥40岁的心脏病风险较高的参加者，他们接受了住院的非心脏手术。主要结果是30天死亡或心肌损伤。次要结局为30天死亡或心肌梗塞，住院中至重度并发症以及1年死亡或新残疾。多变量logistic回归模型用于表征术前DASI评分与预后的校正关联。结果DASI得分与结果呈非线性关系。自我报告的功能能力优于DASI得分34与30天死亡或心肌损伤的几率降低相关（赔率比：高于34则每增加1分0.97； 95％置信区间[CI]：0.96-0.99）和1年死亡或新残障（赔率：高于34，每增加1分增加0.96； 95％CI：0.92-0.99）。自我报告的功能能力差于DASI得分34分与30天死亡或心肌梗死的几率增加相关（赔率：每1分1.05降低到34以下； 95％CI：1.00-1.09），以及中度至-严重并发症（赔率：每1分1.03降低到34以下； 95％CI：1.01-1.05）。
更新日期：2019-12-19
中文翻译：
将杜克活动状态指数纳入术前风险评估：一项多中心前瞻性队列研究。
背景技术杜克活动状态指数（DASI）调查表可能有助于将自我报告的功能能力纳入术前风险评估。尽管如此，DASI评分的预后重要阈值仍不清楚。我们对手术前运动耐力测量（METS）研究进行了嵌套队列研究，以表征术前DASI评分与术后死亡或并发症的相关性。方法该分析纳入了1546名年龄≥40岁的心脏病风险较高的参加者，他们接受了住院的非心脏手术。主要结果是30天死亡或心肌损伤。次要结局为30天死亡或心肌梗塞，住院中至重度并发症以及1年死亡或新残疾。多变量logistic回归模型用于表征术前DASI评分与预后的校正关联。结果DASI得分与结果呈非线性关系。自我报告的功能能力优于DASI得分34与30天死亡或心肌损伤的几率降低相关（赔率比：高于34则每增加1分0.97； 95％置信区间[CI]：0.96-0.99）和1年死亡或新残障（赔率：高于34，每增加1分增加0.96； 95％CI：0.92-0.99）。自我报告的功能能力差于DASI得分34分与30天死亡或心肌梗死的几率增加相关（赔率：每1分1.05降低到34以下； 95％CI：1.00-1.09），以及中度至-严重并发症（赔率：每1分1.03降低到34以下； 95％CI：1.01-1.05）。
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