Department of Anesthesiology, Universitair Medisch Centrum Utrecht, The Netherlands.
Department of Cardiology, Universitair Medisch Centrum Utrecht, The Netherlands.
Eur J Prev Cardiol. 2021 Apr 23;28(3):262-269. doi: 10.1177/2047487320906918.
Functional capacity is used as an indicator for cardiac testing before non-cardiac surgery and is often performed subjectively. However, the value of subjectively estimated functional capacity in predicting cardiac complications is under debate. We determined the predictive value of subjectively assessed functional capacity on postoperative cardiac complications and mortality.
An observational cohort study in patients aged 60 years and over undergoing elective inpatient non-cardiac surgery in a tertiary referral hospital.
Subjective functional capacity was determined by anaesthesiologists. The primary outcome was postoperative myocardial injury. Secondary outcomes were postoperative inhospital myocardial infarction and one year mortality. Logistic regression analysis and area under the receiver operating curves were used to determine the added value of functional capacity.
A total of 4879 patients was included; 824 (17%) patients had a poor subjective functional capacity. Postoperative myocardial injury occurred in 718 patients (15%). Poor functional capacity was associated with myocardial injury (relative risk (RR) 1.7, 95% confidence interval (CI) 1.5-2.0; P < 0.001), postoperative myocardial infarction (RR 2.9, 95% CI 1.9-4.2; P < 0.001) and one year mortality (RR 1.7, 95% CI 1.4-2.0; P < 0.001). After adjustment for other predictors, functional capacity was still a significant predictor for myocardial injury (odds ratio (OR) 1.3, 95% CI 1.0-1.7; P = 0.023), postoperative myocardial infarction (OR 2.0, 95% CI 1.3-3.0; P = 0.002) and one year mortality (OR 1.4, 95% CI 1.1-1.8; P = 0.003), but had no added value on top of other predictors.
Subjectively assessed functional capacity is a predictor of postoperative myocardial injury and death, but had no added value on top of other preoperative predictors.
体能通常作为非心脏手术前心脏检查的指标，且通常是主观进行的。然而，主观评估的体能在预测心脏并发症方面的价值仍存在争议。我们旨在确定主观评估的体能对术后心脏并发症和死亡率的预测价值。
在一家三级转诊医院中，对 60 岁及以上接受择期住院非心脏手术的患者进行的观察性队列研究。
由麻醉师确定主观的体能。主要结局是术后心肌损伤。次要结局是术后院内心肌梗死和一年死亡率。采用逻辑回归分析和受试者工作特征曲线下面积来确定体能的附加价值。
共纳入 4879 例患者；824 例（17%）患者主观体能较差。718 例（15%）患者发生术后心肌损伤。较差的体能与心肌损伤（相对风险 1.7，95%置信区间 1.5-2.0；P<0.001）、术后心肌梗死（相对风险 2.9，95%置信区间 1.9-4.2；P<0.001）和一年死亡率（相对风险 1.7，95%置信区间 1.4-2.0；P<0.001）相关。在调整其他预测因素后，体能仍然是心肌损伤（优势比 1.3，95%置信区间 1.0-1.7；P=0.023）、术后心肌梗死（优势比 2.0，95%置信区间 1.3-3.0；P=0.002）和一年死亡率（优势比 1.4，95%置信区间 1.1-1.8；P=0.003）的显著预测因素，但在其他预测因素之外并无附加价值。
主观评估的体能是术后心肌损伤和死亡的预测因素，但在其他术前预测因素之外并无附加价值。
