| Title: |
Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study |
| Authors: |
Wijeysundera, Duminda N; Pearse, Rupert M; Shulman, Mark A; Abbott, Tom E F; Torres, Elizabeth; Ambosta, Althea; Croal, Bernard L; Granton, John T; Thorpe, Kevin E; Grocott, Michael P W; Farrington, Catherine; Ahmad, Tahania; Whalley, Jan; Haslop, Richard; McNeil, Jane; Thompson, Bruce; Ismail, Hilmy; Brown, Alistair; Masel, Philip; MacDonald, Neil; Pakats, Mari Liis; Terblanche, Nico CS; Greaves, Kathryn; Jhanji, Shaman; Raobaikady, Ravishanar; Black, Ethel; Rooms, Martin; Lawrence, Helen; Koutra, Maria; Riedel, Bernhard; Dent, Annette; Ellis, Mathew; Pitt, Simon; Pirie, Katrina; Gertsman, Michelle; Jack, Sandy; Celinski, Michael; Levett, Denny; Edwards, Mark; Salmon, Karen; Bolger, Clare; Loughney, Lisa; Smith, Emma; Samuel, Joanne; Melville, Andrew; Seaward, Leanne; Borg, Brigette; Collins, Hannah; Tyrell, Bryony; Tantony, Natasha; Golder, Kim; Ackland, Gareth L; Stephens, RCM; Gallego-Paredes, Laura; Wilde, Chris; Bodger, Alanna; Reyes, Anna; Sivakumar, Harry; Gutierrez del Arroyo, Ana; Raj, Ashok; Kerridge, Ross K; Lifford, Rhiannon; Melo, Magda; Mamdani, Muhammad; Hillis, Graham; Leslie, Kate; Wijeysundera, Harindra C; Abolfathi, Miriam; Douglas, Jeanene; Brannan, John; Murmane, Andrew; Pretto, Jeff; Godsall, Guy; Beauchamp, Nicola; Allen, Sandra; Kennedy, Ann; Kim, Chang Joon; Kenchington, Kay; Kirabiyik, Yesim; Sivalingam, Pal; Gurunathan, Usha; Kumar, Jonathan; Stonell, Chris; Brunello, Kate; Steele, Katherine; Waymouth, Ellen; Hall, Adrian; MacCormick, Andrew; Painter, Thomas W; Hurford, Sally; Macklin, Simon; Elliott, Adrian; Carrera, Anna Maria; Hunt, Anna; Bramley, David; Southcott, Anne Marie; Pinto, Manuel; Grant, John; Taylor, Hugh; Bates, Samantha; Towns, Miriam; Tippett, Anna; Marshall, Fiona; Mazer, C David; Dimech, Julian; Andrews, Lynn; Kunasingam, Janarthanee; Kynaston, Stephen; Yagnik, Anmol; Crescini, Charmagne; Yagnik, Sanjay; McCartney, Colin JL; Somascanthan, Priya; Choi, Stephen; Flores, Kathrina; Au, Shelly; Beattie, W Scott; Navarra, Leanlove; Phull, Mandeep; Lorimer, Michael; Karkouti, Keyvan; Clarke, Hance A; Jerath, Angela; McCluskey, Stuart A; Wasowicz, Marcin; Day, Lauren; Pazmino-Canizares, Janneth; Oh, Paul; Belliard, Rene; Beilstein, Christian; Jason-Smith, Adelaide; Lee, Leanna; Tai, Joyce; Dobson, Karen; Chan, Vincent; Brull, Richard; Ami, Noam; Stanbrook, Matthew; Hagen, Katherine; Campbell, Douglas; Bodger, Pheobe; Short, Timothy; Thompson, Helen; Van Der Westhuizen, Joreline; Higgie, Kushlin; Miller, Reuben; Lindsay, Helen; Jang, Ryan; Wong, Chris; McAllister, Davina; Ali, Marlynn; Wallace, Sophie; Sara, Rachel; Collingwood, Andrew; McMillan, Natalie; Olliff, Sue; Myles, Paul S; Gabriel, Sharon; Houston, Helen; Dalley, Paul; Cuthbertson, Brian H; Back, Geraldine; Everingham, Kirsty; Lum, Mark; Wright, Ewan; Martin, Daniel; James, Sarah; Filipe, Helder; Malherbe, Johan; Hu, Ying; Niebrzegowska, Edyta; Tronstad, Oystein; Corriea, Carmen; Creary, Thais; Januszewska, Marta |
| Publisher Information: |
University of Toronto |
| Publication Year: |
2018 |
| Collection: |
University of Toronto: Research Repository T-Space |
| Description: |
Background: Functional capacity is an important component of risk assessment for major surgery. Doctors' clinical subjective assessment of patients' functional capacity has uncertain accuracy. We did a study to compare preoperative subjective assessment with alternative markers of fitness (cardiopulmonary exercise testing [CPET], scores on the Duke Activity Status Index [DASI] questionnaire, and serum N-terminal pro-B-type natriuretic peptide [NT pro-BNP] concentrations) for predicting death or complications after major elective non-cardiac surgery. Methods: We did a multicentre, international, prospective cohort study at 25 hospitals: five in Canada, seven in the UK, ten in Australia, and three in New Zealand. We recruited adults aged at least 40 years who were scheduled for major non-cardiac surgery and deemed to have one or more risk factors for cardiac complications (eg, a history of heart failure, stroke, or diabetes) or coronary artery disease. Functional capacity was subjectively assessed in units of metabolic equivalents of tasks by the responsible anaesthesiologists in the preoperative assessment clinic, graded as poor (10). All participants also completed the DASI questionnaire, underwent CPET to measure peak oxygen consumption, and had blood tests for measurement of NT pro-BNP concentrations. After surgery, patients had daily electrocardiograms and blood tests to measure troponin and creatinine concentrations until the third postoperative day or hospital discharge. The primary outcome was death or myocardial infarction within 30 days after surgery, assessed in all participants who underwent both CPET and surgery. Prognostic accuracy was assessed using logistic regression, receiver-operating-characteristic curves, and net risk reclassification. Findings: Between March 1, 2013, and March 25, 2016, we included 1401 patients in the study. 28 (2%) of 1401 patients died or had a myocardial infarction within 30 days of surgery. Subjective assessment had 19·2% sensitivity ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| Relation: |
http://hdl.handle.net/1807/99745 |
| DOI: |
10.1016/S0140-6736(18)31131-0 |
| Availability: |
http://hdl.handle.net/1807/99745; https://doi.org/10.1016/S0140-6736(18)31131-0 |
| Rights: |
Attribution-NonCommercial-NoDerivatives 4.0 International ; http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| Accession Number: |
edsbas.F23FA03C |
| Database: |
BASE |