患者报告的问卷，用于术前识别高危手术患者。
Patient-reported questionnaires to preoperatively identify high-risk surgical patients.
作者信息
Meijer Renske, Cate David W G Ten, Bongers Bart C, Regis Marta, Savelberg Hans H C M, Slooter Gerrit D, Janssen Stef, van Hooff Martijn, Schep Goof
机构信息
Department of Sports Medicine, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands.
Department of Nutrition and Movement Sciences, NUTRIM, Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
出版信息
Langenbecks Arch Surg. 2024 Dec 5;409(1):372. doi: 10.1007/s00423-024-03560-0.
PURPOSE
Low cardiorespiratory fitness (CRF) increases the risk of postoperative morbidity and mortality following major surgery. Assessing CRF preoperatively, by measuring peak oxygen uptake (VO) during cardiopulmonary exercise testing (CPET), is valuable yet not widely available. This study aimed to assess whether questionnaires could be used preoperatively to identify high-risk surgical patients.
METHODS
Healthy participants and patients who underwent CPET completed the FitMáx, Duke Activity Status Index (DASI), the modified 4-questions DASI (M-DASI-4Q), Veterans-Specific Activity Questionnaire (VSAQ), and Metabolic Equivalents of Task (MET) questionnaire. Questionnaire-VO was compared with CPET-VO. Overall performance of the questionnaires was assessed by the area under the curve (AUC) of receiver operating characteristic (ROC) curves. Furthermore, corresponding to the Youden index or pre-specified levels, sensitivity, specificity, and predictive values were determined.
RESULTS
In total, 361 participants were included. All questionnaires showed high AUC values to identify high-risk patients, defined on the basis of CPET-VO thresholds. FitMáx and VSAQ demonstrated superior results compared to the other questionnaires. Based on the Youden index, the optimal questionnaire-VO cut-off values were 20.6, 21.3, and 26.1 ml·kg·min for the FitMáx and 16.3, 18.2, and 20.4 ml·kg·min for the VSAQ corresponding to the VO thresholds 16.0, 18.2 and 24.5 ml·kg·min respectively.
CONCLUSION
The ability to identify high-risk surgical patients preoperatively (defined by the CPET-VO thresholds) by the FitMáx and the VSAQ indicates that they could be used to identify high-risk surgical patients. Patients with a poor predicted VO ≤ 21.3 and ≤ 18.2 ml·kg·min, respectively for FitMáx and VSAQ, should be referred to formal preoperative (cardiopulmonary) exercise testing.
TRIAL REGISTRATION
The study was registered as NL-OMON23304 in the Overview of Medical Research in the Netherlands, retrospectively at 28-04-2020.
目的
低心肺适能（CRF）会增加大手术后的术后发病率和死亡率。通过在心肺运动试验（CPET）期间测量峰值摄氧量（VO）来术前评估CRF很有价值，但尚未广泛应用。本研究旨在评估术前是否可以使用问卷来识别高危手术患者。
方法
健康参与者和接受CPET的患者完成了FitMáx、杜克活动状态指数（DASI）、改良的4问题DASI（M-DASI-4Q）、退伍军人特定活动问卷（VSAQ）和代谢当量（MET）问卷。将问卷得出的VO与CPET得出的VO进行比较。通过受试者操作特征（ROC）曲线的曲线下面积（AUC）评估问卷的整体性能。此外，对应于约登指数或预先指定的水平，确定敏感性、特异性和预测值。
结果
总共纳入了361名参与者。所有问卷在识别基于CPET-VO阈值定义的高危患者方面均显示出较高的AUC值。与其他问卷相比，FitMáx和VSAQ表现出更好的结果。根据约登指数，对应于VO阈值分别为16.0、18.2和24.5 ml·kg·min，FitMáx的最佳问卷-VO截断值为20.6 ml·kg·min、21.3 ml·kg·min和26.1 ml·kg·min，VSAQ的最佳问卷-VO截断值为16.3 ml·kg·min、18.2 ml·kg·min和20.4 ml·kg·min。
结论
FitMáx和VSAQ术前识别高危手术患者（由CPET-VO阈值定义）的能力表明它们可用于识别高危手术患者。对于FitMáx和VSAQ，预测VO分别≤21.3和≤18.2 ml·kg·min的患者应转诊进行正式的术前（心肺）运动测试。
试验注册
该研究于2020年4月28日追溯注册为荷兰医学研究概述中的NL-OMON23304。
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