• Duminda N Wijeysundera, W Scott Beattie, Graham S Hillis, Abbott Tom E F TEF The William Harvey Research Institute, Queen Mary University of London, London, UK; Barts and the London School of Medicine and Dentistry, Queen Mary U, Mark A Shulman, Gareth L Ackland, C David Mazer, Paul S Myles, Rupert M Pearse, Brian H Cuthbertson, Measurement of Exercise Tolerance before Surgery Study Investigators, P S Myles, M A Shulman, S Wallace, C Farrington, B Thompson, M Ellis, B Borg, R K Kerridge, J Douglas, J Brannan, J Pretto, M G Godsall, N Beauchamp, S Allen, A Kennedy, E Wright, J Malherbe, H Ismail, B Riedel, A Melville, H Sivakumar, A Murmane, K Kenchington, Y Kirabiyik, U Gurunathan, C Stonell, K Brunello, K Steele, O Tronstad, P Masel, A Dent, E Smith, A Bodger, M Abolfathi, P Sivalingam, A Hall, T W Painter, S Macklin, A Elliott, A M Carrera, Terblanche N C S NCS Royal Hobart Hospital, Australia., S Pitt, J Samuels, C Wilde, K Leslie, A MacCormick, D Bramley, A M Southcott, J Grant, H Taylor, S Bates, M Towns, A Tippett, F Marshall, C D Mazer, J Kunasingam, A Yagnik, C Crescini, S Yagnik, McCartney C J L CJL Sunnybrook Health Sciences Centre, Canada., S Choi, P Somascanthan, K Flores, D N Wijeysundera, W S Beattie, K Karkouti, H A Clarke, A Jerath, S A McCluskey, M Wasowicz, J T Granton, L Day, J Pazmino-Canizares, P Oh, R Belliard, L Lee, K Dobson, V Chan, R Brull, N Ami, M Stanbrook, K Hagen, D Campbell, T Short, J Van Der Westhuizen, K Higgie, H Lindsay, R Jang, C Wong, D Mcallister, M Ali, J Kumar, E Waymouth, C Kim, J Dimech, M Lorimer, J Tai, R Miller, R Sara, A Collingwood, S Olliff, S Gabriel, H Houston, P Dalley, S Hurford, A Hunt, L Andrews, L Navarra, A Jason-Smith, H Thompson, N McMillan, G Back, B L Croal, M Lum, D Martin, S James, H Filipe, M Pinto, S Kynaston, R M Pearse, Abbott T E F TEF Royal London Hospital, United Kingdom., M Phull, C Beilstein, P Bodger, K Everingham, Y Hu, E Niebrzegowska, C Corriea, T Creary, M Januszewska, T Ahmad, J Whalley, R Haslop, J McNeil, A Brown, N MacDonald, M Pakats, K Greaves, S Jhanji, R Raobaikady, E Black, M Rooms, H Lawrence, M Koutra, K Pirie, M Gertsman, S Jack, M Celinski, D Levett, M Edwards, K Salmon, C Bolger, L Loughney, L Seaward, H Collins, B Tyrell, N Tantony, K Golder, G L Ackland, Stephens R C M RCM University College London Hospital, United Kingdom., L Gallego-Paredes, A Reyes, Gutierrez Del Arroyo A A University College London Hospital, United Kingdom., A Raj, R Lifford, International and National Coordinators, Central Project Office Operations Committee, CPET Methods Committee, Outcome Adjudication Committee, and International Steering Committee.
• Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada. Electronic address: d.wijeysundera@utoronto.ca.
• Br J Anaesth. 2020 Mar 1; 124 (3): 261-270.

BackgroundThe Duke Activity Status Index (DASI) questionnaire might help incorporate self-reported functional capacity into preoperative risk assessment. Nonetheless, prognostically important thresholds in DASI scores remain unclear. We conducted a nested cohort analysis of the Measurement of Exercise Tolerance before Surgery (METS) study to characterise the association of preoperative DASI scores with postoperative death or complications.MethodsThe analysis included 1546 participants (≥40 yr of age) at an elevated cardiac risk who had inpatient noncardiac surgery. The primary outcome was 30-day death or myocardial injury. The secondary outcomes were 30-day death or myocardial infarction, in-hospital moderate-to-severe complications, and 1 yr death or new disability. Multivariable logistic regression modelling was used to characterise the adjusted association of preoperative DASI scores with outcomes.ResultsThe DASI score had non-linear associations with outcomes. Self-reported functional capacity better than a DASI score of 34 was associated with reduced odds of 30-day death or myocardial injury (odds ratio: 0.97 per 1 point increase above 34; 95% confidence interval [CI]: 0.96-0.99) and 1 yr death or new disability (odds ratio: 0.96 per 1 point increase above 34; 95% CI: 0.92-0.99). Self-reported functional capacity worse than a DASI score of 34 was associated with increased odds of 30-day death or myocardial infarction (odds ratio: 1.05 per 1 point decrease below 34; 95% CI: 1.00-1.09), and moderate-to-severe complications (odds ratio: 1.03 per 1 point decrease below 34; 95% CI: 1.01-1.05).ConclusionsA DASI score of 34 represents a threshold for identifying patients at risk for myocardial injury, myocardial infarction, moderate-to-severe complications, and new disability.Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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