• Lurati Buse Giovanna A L GAL Anaesthesiology Department, University Hospital Düsseldorf, Düsseldorf, Germany. Electronic address: Giovanna.luratibuse@med.uni-duesseldorf., Christian Puelacher, Danielle Menosi Gualandro, Alessandro S Genini, Reka Hidvegi, Daniel Bolliger, Ketina Arslani, Luzius A Steiner, Christoph Kindler, Christian Mueller, and BASEL-PMI Investigators.
• Anaesthesiology Department, University Hospital Düsseldorf, Düsseldorf, Germany. Electronic address: Giovanna.luratibuse@med.uni-duesseldorf.de.
• Br J Anaesth. 2021 Jan 1; 126 (1): 102-110.

BackgroundPerioperative cardiovascular guidelines endorse functional capacity estimation, based on 'cut-off' daily activities for risk assessment and climbing two flights of stairs to approximate 4 metabolic equivalents. We assessed the association between self-reported functional capacity and postoperative cardiac events.MethodsConsecutive patients at elevated cardiovascular risk undergoing in-patient noncardiac surgery were included in this predefined secondary analysis. Self-reported ability to walk up two flights of stairs was extracted from electronic charts. The primary endpoint was a composite of cardiac death and cardiac events at 30 days. Secondary endpoints included the same composite at 1 yr, all-cause mortality, and myocardial injury.ResultsAmong the 4560 patients, mean (standard deviation) age 73 (SD 8 yr) yr, classified as American Society of Anesthesiologists physical status ≥3 in 61% (n=2786/4560), the 30-day and 1-yr incidences of major adverse cardiac events were 5.7% (258/4560) and 11.2% (509/4560), respectively. Functional capacity less than two flights of stairs was associated with the 30-day composite endpoint (adjusted hazard ratio 1.63, 95% confidence interval [CI] 1.23-2.15) and all other endpoints. The addition of functional capacity information to the revised cardiac risk index (RCRI) significantly improved risk classification (functional capacity plus RCRI vs RCRI: net reclassification improvement [NRI]Events 6.2 [95% CI 3.6-9.9], NRINonevents19.2 [95% CI 18.1-20.0]).ConclusionsIn patients at high cardiovascular risk undergoing noncardiac surgery, self-reported functional capacity less than two flights of stairs was independently associated with major adverse cardiac events and all-cause mortality at 30 days and 1 yr. The addition of self-reported functional capacity to surgical and clinical risk improved risk classification.Clinical Trial RegistrationINCT 02573532.Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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