Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Centre for Integrated Critical Care Medicine, University of Melbourne, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.
Br J Anaesth. 2021 Jan;126(1):181-190. doi: 10.1016/j.bja.2020.06.016. Epub 2020 Jul 18.
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.
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 min and peak oxygen consumption (VO peak) >16 ml kg min, cut-points that represent a reduced risk of postoperative complications.
Five questions were identified to have dominance in predicting AT>11 ml kg min and VO peak>16 ml.kgmin. These items were included in the M-DASI-5Q and retained utility in predicting AT>11 ml.kg.min (area under the receiver-operating-characteristic [AUROC]-AT: M-DASI-5Q=0.67 vs original 12-question DASI=0.66) and VO 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 VO peak>16 ml.kg.min and VO peak<16 ml.kg.min.
The M-DASI provides a simple screening tool for further preoperative evaluation, including with cardiopulmonary exercise testing, to guide perioperative management.
准确评估功能能力，这是预测术后发病率和死亡率的指标，对于改善手术计划和结果至关重要。我们评估了杜克活动状态指数（DASI）的 12 个项目是否在反映运动能力方面同样重要。
在国际多中心术前运动耐量测量（METS）研究的二次横断面分析中，我们评估了 1455 名参与者的心肺运动测试和 DASI 数据。使用多变量回归分析对 DASI 模型进行修订，以预测无氧阈值（AT）>11 ml·kg·min 和峰值摄氧量（VOpeak）>16 ml·kg·min，这些切点代表术后并发症风险降低。
确定了五个问题，这些问题在预测 AT>11 ml·kg·min 和 VOpeak>16 ml·kg·min 方面具有主导地位。这些项目被纳入 M-DASI-5Q，并保留了预测 AT>11 ml·kg·min 的效用（AT：M-DASI-5Q=0.67 与原始 12 项 DASI=0.66）和 VOpeak（VO2peak：M-DASI-5Q=0.73 与原始 12 项 DASI=0.71）。相反，在敏感性分析中，我们删除了一个与性能力相关的潜在敏感问题，剩余四个问题（M-DASI-4Q）预测足够功能阈值的能力并不比原始 12 项 DASI 模型差。通过评估运动时的变时反应，在 M-DASI-4Q 中添加动态成分，提高了其区分 VOpeak>16 ml·kg·min 和 VOpeak<16 ml·kg·min 患者的能力。
M-DASI 提供了一种简单的筛查工具，可用于进一步的术前评估，包括心肺运动测试，以指导围手术期管理。
