Open this publication in new window or tab >>Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium.
Division of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
Department of Anaesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain.
Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
Department of Anesthesiology and ICU, Ankara University Medical School, Ankara, Turkey.
Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Anesthesiology, Hospital Beatriz Ângelo, Loures, Portugal.
Aretaieion University Hospital National and Kapodistrian University of Athens, Athens, Greece.
Department of Perioperative Medicine and Intensive Care, Karolinska Hospital and Institution for Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
Anesthesia and Intensive Care Department, University Hospital, Varese, Italy.
Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland.
Department of Anesthesiology and Critical Care Medicine, University Hospital Marburg, Marburg, Germany.
Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
Carol Davila University of Medicine and Pharmacy Bucharest Head of Anesthesia and Intensive Care Department I, Central Military Emergency University Hospital "Dr. Carol Davila", Bucharest, Romania.
Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland.
Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US. Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology.
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2023 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 130, no 6, p. 655-665Article in journal (Refereed) Published
Abstract [en]
Background: Guidelines endorse self-reported functional capacity for preoperative cardiovascular assessment, although evidence for its predictive value is inconsistent. We hypothesised that self-reported effort tolerance improves prediction of major adverse cardiovascular events (MACEs) after noncardiac surgery.
Methods: This is an international prospective cohort study (June 2017 to April 2020) in patients undergoing elective noncardiac surgery at elevated cardiovascular risk. Exposures were (i) questionnaire-estimated effort tolerance in metabolic equivalents (METs), (ii) number of floors climbed without resting, (iii) self-perceived cardiopulmonary fitness compared with peers, and (iv) level of regularly performed physical activity. The primary endpoint was in-hospital MACE consisting of cardiovascular mortality, non-fatal cardiac arrest, acute myocardial infarction, stroke, and congestive heart failure requiring transfer to a higher unit of care or resulting in a prolongation of stay on ICU/intermediate care (≥24 h). Mixed-effects logistic regression models were calculated.
Results: In this study, 274 (1.8%) of 15 406 patients experienced MACE. Loss of follow-up was 2%. All self-reported functional capacity measures were independently associated with MACE but did not improve discrimination (area under the curve of receiver operating characteristic [ROC AUC]) over an internal clinical risk model (ROC AUCbaseline 0.74 [0.71-0.77], ROC AUCbaseline+4METs 0.74 [0.71-0.77], ROC AUCbaseline+floors climbed 0.75 [0.71-0.78], AUCbaseline+fitnessvspeers 0.74 [0.71-0.77], and AUCbaseline+physical activity 0.75 [0.72-0.78]).
Conclusions: Assessment of self-reported functional capacity expressed in METs or using the other measures assessed here did not improve prognostic accuracy compared with clinical risk factors. Caution is needed in the use of self-reported functional capacity to guide clinical decisions resulting from risk assessment in patients undergoing noncardiac surgery.
Clinical trial registration: NCT03016936.
Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
cohort study; effort tolerance; functional capacity; major adverse cardiovascular events; noncardiac surgery; perioperative; postoperative complications; preoperative period; risk assessment
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-202836 (URN)10.1016/j.bja.2023.02.030 (DOI)001004286500001 ()37012173 (PubMedID)
2024-04-222024-04-222024-04-22