Clinical Tools to Assess Functional Capacity During Risk Assessment Before Elective Noncardiac Surgery : A Scoping Review.

Autor:	Daza JF; Division of General Surgery, Department of Surgery, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (J.F.D.)., Chesney TR; Division of General Surgery, Department of Surgery, University of Toronto, Toronto; Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto; and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada (T.R.C.)., Morales JF; Department of Anesthesia, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada (J.F.M.)., Xue Y; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Y.X., S.L.)., Lee S; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Y.X., S.L.)., Amado LA; Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada (L.A.A., A.R.M.H.)., Pivetta B; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada (B.P., R.J.)., Mbadjeu Hondjeu AR; Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada (L.A.A., A.R.M.H.)., Jolley R; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada (B.P., R.J.)., Diep C; Institute of Health Policy, Management and Evaluation, and Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada (C.D.)., Alibhai SMH; Institute of Health Policy, Management and Evaluation, and Department of Medicine, University of Toronto, Toronto; and Department of Medicine, University Health Network, Toronto, Ontario, Canada (S.M.H.A.)., Smith PM; Institute for Work & Health, Toronto; and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (P.M.S.)., Kennedy ED; Division of General Surgery, Department of Surgery, University of Toronto, Toronto; and Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada (E.D.K.)., Racz E; Patient and Family Partner Program, Unity Health Toronto, Toronto, Ontario, Canada (E.R., L.W.)., Wilmshurst L; Patient and Family Partner Program, Unity Health Toronto, Toronto, Ontario, Canada (E.R., L.W.)., Wijeysundera DN; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto; Department of Anesthesia, St. Michael's Hospital, Unity Health Toronto, Toronto; and Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada (D.N.W.).
Jazyk:	angličtina
Zdroj:	Annals of internal medicine [Ann Intern Med] 2024 Nov 12. Date of Electronic Publication: 2024 Nov 12.
DOI:	10.7326/ANNALS-24-00413
Abstrakt:	Background: Functional capacity is critical to preoperative risk assessment, yet guidance on its measurement in clinical practice remains lacking. Purpose: To identify functional capacity assessment tools studied before surgery and characterize the extent of evidence regarding performance, including in populations where assessment is confounded by noncardiopulmonary reasons. Data Sources: MEDLINE, EMBASE, and EBM Reviews (until July 2024). Study Selection: Studies evaluating performance of functional capacity assessment tools administered before elective noncardiac surgery to stratify risk for postoperative outcomes. Data Extraction: Study details, measurement properties, pragmatic qualities, and/or clinical utility metrics. Data Synthesis: 6 categories of performance-based tests and 5 approaches using patient-reported exercise tolerance were identified. Cardiopulmonary exercise testing (CPET) was the most studied tool (132 studies, 32 662 patients) followed by field walking tests (58 studies, 9393 patients) among performance-based tests. Among patient-reported assessments, the Duke Activity Status Index (14 studies, 3303 patients) and unstructured assessments (19 studies, 28 520 patients) were most researched. Most evidence focused on predictive validity (92% of studies), specifically accuracy in predicting cardiorespiratory complications. Several tools lacked evidence on reliability (test consistency across similar measurements), pragmatic qualities (feasibility of implementation), or concurrent criterion validity (correlation to gold standard). Only CPET had evidence on clinical utility (whether administration improved postoperative outcomes). Older adults (≥65 years) were well represented across studies, whereas there were minimal data in patients with obesity, lower-limb arthritis, and disability. Limitation: Synthesis focused on reported data without requesting missing information. Conclusion: Though several tools for preoperative functional capacity assessment have been studied, research has overwhelmingly focused on CPET and only 1 aspect of validity (predictive validity). Important evidence gaps remain among vulnerable populations with obesity, arthritis, and physical disability. Primary Funding Source: None. (Open Science Framework: https://osf.io/ah7u5). Competing Interests: Disclosures: Disclosure forms are available with the article online.
Databáze:	MEDLINE
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