| Autor: |
Harindra C. Wijeysundera, Marcin Wasowicz, M. Ellis, S. Pitt, Robert C M Stephens, Ethel Black, N. McMillan, B. Riedel, J. Tai, Manuel Pinto, Lisa Loughney, C. Wilde, D. Bramley, H. Thompson, H. Lawrence, Y. Kirabiyik, E. Smith, C. Bolger, Usha Gurunathan, N. Tantony, Hannah Collins, Timothy G. Short, A. Raj, Thais Creary, N. Ami, B. Borg, S. Gabriel, A.M. Southcott, S. Yagnik, D. Campbell, A. Hunt, Chang Joon Kim, Paul Oh, T. Ahmad, Sarah James, C. Crescini, K. Hagen, J. Malherbe, M. Lorimer, R. Raobaikady, D. Mcallister, R. Jang, Annette Dent, L. Day, Philip Masel, Helder Filipe, W.S. Beattie, J.K. Higgie, Thomas Painter, M. Gertsman, Angela Jerath, H. Sivakumar, Christopher X. Wong, A. Jason-Smith, M. Stanbrook, Marta Januszewska, L. Lee, Keyvan Karkouti, Phoebe Bodger, G. Back, P. Sivalingam, Michael H-G. Li, Andrew Macalister Hall, Hugh Taylor, J. Douglas, Helen Houston, K. Steele, R. Belliard, Kirsty Everingham, Ellen Waymouth, Shelly Au, S. Macklin, C.H. Angus Lee, E. Wright, Bruce Thompson, A. Bodger, Jeffrey J. Pretto, Mark J. Edwards, Edyta Niebrzegowska, J. Whalley, Fiona H. Marshall, M. Lum, S. Allen, Mandeep-Kaur Phull, C.D. Mazer, Christopher A. Stonell, Daniel Martin, K. Brunello, John J McNeil, Sandy Jack, Neil MacDonald, A. Gutierrez del Arroyo, S. Bates, Richard Brull, Graham S Hillis, A. Kennedy, J. Kunasingam, J. Pazmino-Canizares, Hilmy Ismail, Karen Salmon, M. Towns, L. Andrews, Gareth L. Ackland, M. Melo, A. Murmane, Kwok M. Ho, Karen Dobson, K. Pirie, R. Miller, J. Samuels, Richard Haslop, J. Brannan, J. Kumar, R Kerridge, Michael Celinski, S. Wallace, John Grant, P. Dalley, Leanne Seaward, Colin J L McCartney, Christian M. Beilstein, Stuart A. McCluskey, J. Van Der Westhuizen, Shaman Jhanji, S. Kynaston, Kate Leslie, L. Gallego-Paredes, J. Dimech, R. Lifford, M.G. Godsall, Vincent W. S. Chan, Andrew M. Brown, L. Navarra, Ying Hu, Marlynn Ali, M. Koutra, Brian H. Cuthbertson, N Terblanche, Stephen Choi, Helen A. Lindsay, M. Abolfathi, Hance Clarke, Bryony Tyrell, Duminda N. Wijeysundera, A.M. Carrera, Martin Rooms, R. Sara, Oystein Tronstad, P. Somascanthan, H. Ismail, K. Greaves, S. Olliff, A. MacCormick, A. Collingwood, Adrian D. Elliott, M. Pakats, Muhammad Mamdani, K. Kenchington, C. Corriea, Denny Z. H. Levett, K. Flores, S. Hurford, Anmol Yagnik, A. Tippett, Bernhard Riedel, Anna Reyes, A. Melville, N. Beauchamp, Kim Golder |
| Rok vydání: |
2020 |
| Předmět: |
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| Zdroj: |
British journal of anaesthesia. 126(1) |
| ISSN: |
1471-6771 |
| Popis: |
Background Accurate assessment of functional capacity, a predictor of postoperative morbidity and mortality, is essential to improving surgical planning and outcomes. We assessed if all 12 items of the Duke Activity Status Index (DASI) were equally important in reflecting exercise capacity. Methods In this secondary cross-sectional analysis of the international, multicentre Measurement of Exercise Tolerance before Surgery (METS) study, we assessed cardiopulmonary exercise testing and DASI data from 1455 participants. Multivariable regression analyses were used to revise the DASI model in predicting an anaerobic threshold (AT) >11 ml kg−1 min−1 and peak oxygen consumption (VO2 peak) >16 ml kg−1 min−1, cut-points that represent a reduced risk of postoperative complications. Results Five questions were identified to have dominance in predicting AT>11 ml kg−1 min−1 and VO2 peak>16 ml.kg−1min−1. These items were included in the M-DASI-5Q and retained utility in predicting AT>11 ml.kg−1.min−1 (area under the receiver-operating-characteristic [AUROC]-AT: M-DASI-5Q=0.67 vs original 12-question DASI=0.66) and VO2 peak (AUROC-VO2 peak: M-DASI-5Q 0.73 vs original 12-question DASI 0.71). Conversely, in a sensitivity analysis we removed one potentially sensitive question related to the ability to have sexual relations, and the ability of the remaining four questions (M-DASI-4Q) to predict an adequate functional threshold remained no worse than the original 12-question DASI model. Adding a dynamic component to the M-DASI-4Q by assessing the chronotropic response to exercise improved its ability to discriminate between those with VO2 peak>16 ml.kg−1.min−1 and VO2 peak Conclusions The M-DASI provides a simple screening tool for further preoperative evaluation, including with cardiopulmonary exercise testing, to guide perioperative management. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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