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Research Letter |

Validated Questionnaire vs Physicians’ Judgment to Estimate Preoperative Exercise Capacity

Christina C. Melon, BA, MSc1; Panteha Eshtiaghi1,3; Warren J. Luksun, MD, FRCPC1; Duminda N. Wijeysundera, MD, PhD, FRCPC1,2
[+] Author Affiliations
1Department of Anesthesia, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
2Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
3undergraduate student at the University of Toronto, Toronto, Ontario, Canada
JAMA Intern Med. 2014;174(9):1507-1508. doi:10.1001/jamainternmed.2014.2914.
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Assessment of exercise capacity is critical to preoperative evaluation. Practice guidelines recommend that patients proceed to noncardiac surgery without further testing if their exercise capacity exceeds 4 metabolic equivalent tasks (METs).1 This assumption that good exercise capacity indicates low perioperative risk is largely extrapolated from studies involving objective exercise testing. Clinical practice instead involves clinicians subjectively estimating exercise capacity by questioning patients about activities of daily living. This method might not accurately predict performance on exercise testing2 or postoperative outcomes.3 Validated questionnaires correlated with objectively measured exercise capacity may help overcome this limitation. We conducted a prospective cohort study to compare physicians’ subjective assessment of preoperative exercise capacity against one such questionnaire, the Duke Activity Status Index (DASI).4

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Figure.
Distribution of Duke Activity Status Index (DASI) Scores Within Strata Defined by Physicians’ Subjective Rating of Functional Capacity

DASI scores are expressed as estimated metabolic equivalent tasks (METs), which were calculated by dividing the raw DASI score by 3.5.5 On the basis of their subjective assessment, physicians categorized patients into any 1 of 3 categories, namely “unfit” (<4 METs), “normal” (4-10 METs), or “fit” (>10 METs). The boxplots represent the distribution of DASI scores within each of the 3 categories of subjective assessment. Each box extends from the 25th to 75th percentiles, while the thick horizontal line within each box represents the median value. The whisker bars denote the minimum and maximum values. Because all patients subjectively rated as “fit” had DASI scores corresponding to 16.3 METs, a single line represents this category. Physicians’ subjective ratings are moderately correlated with DASI scores (Spearman ρ, 0.56; 95% CI, 0.38-0.70).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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