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1. A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study

Author

Wallace, S., Thompson, B., Ellis, M., Borg, B., Kerridge, R.K., Douglas, J., Brannan, J., Pretto, J., Godsall, M.G., Beauchamp, N., Allen, S., Kennedy, A., Wright, E., Malherbe, J., Ismail, H., Riedel, B., Melville, A., Sivakumar, H., Murmane, A., Kenchington, K., Kirabiyik, Y., Gurunathan, U., Stonell, C., Brunello, K., Steele, K., Tronstad, O., Masel, P., Dent, A., Smith, E., Bodger, A., Abolfathi, M., Sivalingam, P., Hall, A., Painter, T.W., Macklin, S., Elliott, A., Carrera, A.M., Terblanche, N.C.S., Pitt, S., Samuels, J., Wilde, C., Leslie, K., MacCormick, A., Bramley, D., Southcott, A.M., Grant, J., Taylor, H., Bates, S., Towns, M., Tippett, A., Marshall, F., Mazer, C.D., Kunasingam, J., Yagnik, A., Crescini, C., Yagnik, S., McCartney, C.J.L., Choi, S., Somascanthan, P., Flores, K., Au, S., Beattie, W.S., Karkouti, K., Clarke, H.A., Jerath, A., McCluskey, S.A., Wasowicz, M., Day, L., Pazmino-Canizares, J., Oh, P., Belliard, R., Lee, L., Dobson, K., Chan, V., Brull, R., Ami, N., Stanbrook, M., Hagen, K., Campbell, D., Short, T., Van Der Westhuizen, J., Higgie, J.K., Lindsay, H., Jang, R., Wong, C., Mcallister, D., Ali, M., Kumar, J., Waymouth, E., Kim, C., Dimech, J., Lorimer, M., Tai, J., Miller, R., Sara, R., Collingwood, A., Olliff, S., Gabriel, S., Houston, H., Dalley, P., Hurford, S., Hunt, A., Andrews, L., Navarra, L., Jason-Smith, A., Thompson, H., McMillan, N., Back, G., Lum, M., Martin, D., S James, S., Filipe, H., Pinto, M., Kynaston, S., Phull, M., Beilstein, C., Bodger, P., Everingham, K., Hu, Y., Niebrzegowska, E., Corriea, C., Creary, T., Januszewska, M., Ahmad, T., Whalley, J., Haslop, R., McNeil, J., Brown, A., MacDonald, N., Pakats, M., Greaves, K., Jhanji, S., Raobaikady, R., Black, E., Rooms, M., Lawrence, H., Koutra, M., Pirie, K., Gertsman, M., Jack, S., Celinski, M., Levett, D., Edwards, M., Salmon, K., Bolger, C., Loughney, L., Seaward, L., Collins, H., Tyrell, B., Tantony, N., Golder, K., Ackland, G.L., Stephens, R.C.M., Gallego-Paredes, L., Reyes, A., Gutierrez del Arroyo, A., Raj, A., R Lifford, R., Melo, M., Mamdani, M., Hillis, G., Wijeysundera, H.C., Riedel, Bernhard, Li, Michael H-G., Lee, C.H. Angus, Ismail, Hilmy, Cuthbertson, Brian H., Wijeysundera, Duminda N., and Ho, Kwok M.

Published
2021
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2. Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study

Author

Cuthbertson, B.H., Wijeysundera, D.N., Pearse, R.M., Myles, P.S., Abbott, T.E.F., Shulman, M.A., Torres, E., Ambosta, A., Melo, M., Mamdani, M., Thorpe, K.E., Wallace, S., Farrington, C., Croal, B.L., Grocott, M.P.W., Granton, J.T., Oh, P., Thompson, B., Levett, D., Hillis, G., Beattie, W.S., Wijeysundera, H.C., Wijeysundera, Duminda N., Beattie, W. Scott, Hillis, Graham S., Abbott, Tom E.F., Shulman, Mark A., Ackland, Gareth L., Mazer, C. David, Myles, Paul S., Pearse, Rupert M., Cuthbertson, Brian H., Ellis, M., Borg, B., Kerridge, R.K., Douglas, J., Brannan, J., Pretto, J., Godsall, M.G., Beauchamp, N., Allen, S., Kennedy, A., Wright, E., Malherbe, J., Ismail, H., Riedel, B., Melville, A., Sivakumar, H., Murmane, A., Kenchington, K., Kirabiyik, Y., Gurunathan, U., Stonell, C., Brunello, K., Steele, K., Tronstad, O., Masel, P., Dent, A., Smith, E., Bodger, A., Abolfathi, M., Sivalingam, P., Hall, A., Painter, T.W., Macklin, S., Elliott, A., Carrera, A.M., Terblanche, N.C.S., Pitt, S., Samuels, J., Wilde, C., Leslie, K., MacCormick, A., Bramley, D., Southcott, A.M., Grant, J., Taylor, H., Bates, S., Towns, M., Tippett, A., Marshall, F., Mazer, C.D., Kunasingam, J., Yagnik, A., Crescini, C., Yagnik, S., McCartney, C.J.L., Choi, S., Somascanthan, P., Flores, K., Karkouti, K., Clarke, H.A., Jerath, A., McCluskey, S.A., Wasowicz, M., Day, L., Pazmino-Canizares, J., Belliard, R., Lee, L., Dobson, K., Chan, V., Brull, R., Ami, N., Stanbrook, M., Hagen, K., Campbell, D., Short, T., Van Der Westhuizen, J., Higgie, K., Lindsay, H., Jang, R., Wong, C., Mcallister, D., Ali, M., Kumar, J., Waymouth, E., Kim, C., Dimech, J., Lorimer, M., Tai, J., Miller, R., Sara, R., Collingwood, A., Olliff, S., Gabriel, S., Houston, H., Dalley, P., Hurford, S., Hunt, A., Andrews, L., Navarra, L., Jason-Smith, A., Thompson, H., McMillan, N., Back, G., Lum, M., Martin, D., James, S., Filipe, H., Pinto, M., Kynaston, S., Phull, M., Beilstein, C., Bodger, P., Everingham, K., Hu, Y., Niebrzegowska, E., Corriea, C., Creary, T., Januszewska, M., Ahmad, T., Whalley, J., Haslop, R., McNeil, J., Brown, A., MacDonald, N., Pakats, M., Greaves, K., Jhanji, S., Raobaikady, R., Black, E., Rooms, M., Lawrence, H., Koutra, M., Pirie, K., Gertsman, M., Jack, S., Celinski, M., Edwards, M., Salmon, K., Bolger, C., Loughney, L., Seaward, L., Collins, H., Tyrell, B., Tantony, N., Golder, K., Ackland, G.L., Stephens, R.C.M., Gallego-Paredes, L., Reyes, A., Gutierrez del Arroyo, A., Raj, A., and Lifford, R.

Published
2020
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3. Association of preoperative anaemia with cardiopulmonary exercise capacity and postoperative outcomes in noncardiac surgery: a substudy of the Measurement of Exercise Tolerance before Surgery (METS) Study

Author

Myles, P.S., Shulman, M.A., Wallace, S., Farrington, C., Thompson, B., Ellis, M., Borg, B., Kerridge, R.K., Douglas, J., Brannan, J., Pretto, J., Godsall, M.G., Beauchamp, N., Allen, S., Kennedy, A., Wright, E., Malherbe, J., Ismail, H., Riedel, B., Melville, A., Sivakumar, H., Murmane, A., Kenchington, K., Kirabiyik, Y., Gurunathan, U., Stonell, C., Brunello, K., Steele, K., Tronstad, O., Masel, P., Dent, A., Smith, E., Bodger, A., Abolfathi, M., Sivalingam, P., Hall, A., Painter, T.W., Macklin, S., Elliott, A., Carrera, A.M., Terblanche, N.C.S., Pitt, S., Samuels, J., Wilde, C., Leslie, K., MacCormick, A., Bramley, D., Southcott, A.M., Grant, J., Taylor, H., Bates, S., Towns, M., Tippett, A., Marshall, F., Mazer, C.D., Kunasingam, J., Yagnik, A., Crescini, C., Yagnik, S., McCartney, C.J.L., Choi, S., Somascanthan, P., Flores, K., Wijeysundera, D.N., Beattie, W.S., Karkouti, K., Clarke, H.A., Jerath, A., McCluskey, S.A., Wasowicz, M., Granton, J.T., Day, L., Pazmino-Canizares, J., Oh, P., Belliard, R., Lee, L., Dobson, K., Chan, V., Brull, R., Ami, N., Stanbrook, M., Hagen, K., Campbell, D., Short, T., Van Der Westhuizen, J., Higgie, K., Lindsay, H., Jang, R., Wong, C., Mcallister, D., Ali, M., Kumar, J., Waymouth, E., Kim, C., Dimech, J., Lorimer, M., Tai, J., Miller, R., Sara, R., Collingwood, A., Olliff, S., Gabriel, S., Houston, H., Dalley, P., Hurford, S., Hunt, A., Andrews, L., Navarra, L., Jason-Smith, A., Thompson, H., McMillan, N., Back, G., Croal, B.L., Lum, M., Martin, D., James, S., Filipe, H., Pinto, M., Kynaston, S., Pearse, R.M., Abbott, T.E.F., Phull, M., Beilstein, C., Bodger, P., Everingham, K., Hu, Y., Niebrzegowska, E., Corriea, C., Creary, T., Januszewska, M., Ahmad, T., Whalley, J., Haslop, R., McNeil, J., Brown, A., MacDonald, N., Pakats, M., Greaves, K., Jhanji, S., Raobaikady, R., Black, E., Rooms, M., Lawrence, H., Koutra, M., Pirie, K., Gertsman, M., Jack, S., Celinski, M., Levett, D., Edwards, M., Salmon, K., Bolger, C., Loughney, L., Seaward, L., Collins, H., Tyrell, B., Tantony, N., Golder, K., Ackland, G.L., Gallego-Paredes, L., Reyes, A., Gutierrez del Arroyo, A., Raj, A., Lifford, R., Cuthbertson, B.H., Torres, E., Ambosta, A., Melo, M., Mamdani, M., Thorpe, K.E., Grocott, M.P.W., Hillis, G., Wijeysundera, H.C., Bartoszko, J., and Laupacis, A.

Published
2019
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4. Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study

Author

Wijeysundera, DN, Beattie, WS, Hillis, GS, Abbott, TEF, Shulman, MA, Ackland, GL, Mazer, CD, Myles, PS, Pearse, RM, Cuthbertson, BH, Measurement of Exercise Tolerance before Surgery Study Investiga, Wallace, S, Farrington, C, Thompson, B, Ellis, M, Borg, B, Kerridge, RK, Douglas, J, Brannan, J, Pretto, J, Godsall, MG, Beauchamp, N, Allen, S, Kennedy, A, Wright, E, Malherbe, J, Ismail, H, Riedel, B, Melville, A, Sivakumar, H, Murmane, A, Kenchington, K, Kirabiyik, Y, Gurunathan, U, Stonell, C, Brunello, K, Steele, K, Tronstad, O, Masel, P, Dent, A, Smith, E, Bodger, A, Abolfathi, M, Sivalingam, P, Hall, A, Painter, TW, Macklin, S, Elliott, A, Carrera, AM, Terblanche, NCS, Pitt, S, Samuels, J, Wilde, C, Leslie, K, MacCormick, A, Bramley, D, Southcott, AM, Grant, J, Taylor, H, Bates, S, Towns, M, Tippett, A, Marshall, F, Kunasingam, J, Yagnik, A, Crescini, C, Yagnik, S, McCartney, CJL, Choi, S, Somascanthan, P, Flores, K, Karkouti, K, Clarke, HA, Jerath, A, McCluskey, SA, Wasowicz, M, Granton, JT, Day, L, Pazmino-Canizares, J, Oh, P, Belliard, R, Lee, L, Dobson, K, Chan, V, Brull, R, Ami, N, Stanbrook, M, Hagen, K, Campbell, D, Short, T, Van Der Westhuizen, J, Higgie, K, Lindsay, H, Jang, R, Wong, C, Mcallister, D, Ali, M, Kumar, J, Waymouth, E, Kim, C, Dimech, J, Lorimer, M, Tai, J, Miller, R, Sara, R, Collingwood, A, Olliff, S, Gabriel, S, Houston, H, Dalley, P, Hurford, S, Hunt, A, Andrews, L, Navarra, L, Jason-Smith, A, Thompson, H, McMillan, N, Back, G, Croal, BL, Lum, M, Martin, D, James, S, Filipe, H, Pinto, M, Kynaston, S, Phull, M, Beilstein, C, Bodger, P, Everingham, K, Hu, Y, Niebrzegowska, E, Corriea, C, Creary, T, Januszewska, M, Ahmad, T, Whalley, J, Haslop, R, McNeil, J, Brown, A, MacDonald, N, Pakats, M, Greaves, K, Jhanji, S, Raobaikady, R, Black, E, Rooms, M, Lawrence, H, Koutra, M, Pirie, K, Gertsman, M, Jack, S, Celinski, M, Levett, D, Edwards, M, Salmon, K, Bolger, C, Loughney, L, Seaward, L, Collins, H, Tyrell, B, Tantony, N, Golder, K, Stephens, RCM, Gallego-Paredes, L, Reyes, A, Gutierrez Del Arroyo, A, Raj, A, Lifford, R, International and National Coordinators, Central Project Office Operations Committee, CPET Methods Committee, Outcome Adjudication Committee, and International Steering Committee

Abstract

BACKGROUND: The 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. METHODS: The 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. RESULTS: The 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). CONCLUSIONS: A DASI score of 34 represents a threshold for identifying patients at risk for myocardial injury, myocardial infarction, moderate-to-severe complications, and new disability.

Published
2020

5. A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study

Author

Riedel, Bernhard, primary, Li, Michael H-G., additional, Lee, C.H. Angus, additional, Ismail, Hilmy, additional, Cuthbertson, Brian H., additional, Wijeysundera, Duminda N., additional, Ho, Kwok M., additional, Wallace, S., additional, Thompson, B., additional, Ellis, M., additional, Borg, B., additional, Kerridge, R.K., additional, Douglas, J., additional, Brannan, J., additional, Pretto, J., additional, Godsall, M.G., additional, Beauchamp, N., additional, Allen, S., additional, Kennedy, A., additional, Wright, E., additional, Malherbe, J., additional, Ismail, H., additional, Riedel, B., additional, Melville, A., additional, Sivakumar, H., additional, Murmane, A., additional, Kenchington, K., additional, Kirabiyik, Y., additional, Gurunathan, U., additional, Stonell, C., additional, Brunello, K., additional, Steele, K., additional, Tronstad, O., additional, Masel, P., additional, Dent, A., additional, Smith, E., additional, Bodger, A., additional, Abolfathi, M., additional, Sivalingam, P., additional, Hall, A., additional, Painter, T.W., additional, Macklin, S., additional, Elliott, A., additional, Carrera, A.M., additional, Terblanche, N.C.S., additional, Pitt, S., additional, Samuels, J., additional, Wilde, C., additional, Leslie, K., additional, MacCormick, A., additional, Bramley, D., additional, Southcott, A.M., additional, Grant, J., additional, Taylor, H., additional, Bates, S., additional, Towns, M., additional, Tippett, A., additional, Marshall, F., additional, Mazer, C.D., additional, Kunasingam, J., additional, Yagnik, A., additional, Crescini, C., additional, Yagnik, S., additional, McCartney, C.J.L., additional, Choi, S., additional, Somascanthan, P., additional, Flores, K., additional, Au, S., additional, Beattie, W.S., additional, Karkouti, K., additional, Clarke, H.A., additional, Jerath, A., additional, McCluskey, S.A., additional, Wasowicz, M., additional, Day, L., additional, Pazmino-Canizares, J., additional, Oh, P., additional, Belliard, R., additional, Lee, L., additional, Dobson, K., additional, Chan, V., additional, Brull, R., additional, Ami, N., additional, Stanbrook, M., additional, Hagen, K., additional, Campbell, D., additional, Short, T., additional, Van Der Westhuizen, J., additional, Higgie, J.K., additional, Lindsay, H., additional, Jang, R., additional, Wong, C., additional, Mcallister, D., additional, Ali, M., additional, Kumar, J., additional, Waymouth, E., additional, Kim, C., additional, Dimech, J., additional, Lorimer, M., additional, Tai, J., additional, Miller, R., additional, Sara, R., additional, Collingwood, A., additional, Olliff, S., additional, Gabriel, S., additional, Houston, H., additional, Dalley, P., additional, Hurford, S., additional, Hunt, A., additional, Andrews, L., additional, Navarra, L., additional, Jason-Smith, A., additional, Thompson, H., additional, McMillan, N., additional, Back, G., additional, Lum, M., additional, Martin, D., additional, S James, S., additional, Filipe, H., additional, Pinto, M., additional, Kynaston, S., additional, Phull, M., additional, Beilstein, C., additional, Bodger, P., additional, Everingham, K., additional, Hu, Y., additional, Niebrzegowska, E., additional, Corriea, C., additional, Creary, T., additional, Januszewska, M., additional, Ahmad, T., additional, Whalley, J., additional, Haslop, R., additional, McNeil, J., additional, Brown, A., additional, MacDonald, N., additional, Pakats, M., additional, Greaves, K., additional, Jhanji, S., additional, Raobaikady, R., additional, Black, E., additional, Rooms, M., additional, Lawrence, H., additional, Koutra, M., additional, Pirie, K., additional, Gertsman, M., additional, Jack, S., additional, Celinski, M., additional, Levett, D., additional, Edwards, M., additional, Salmon, K., additional, Bolger, C., additional, Loughney, L., additional, Seaward, L., additional, Collins, H., additional, Tyrell, B., additional, Tantony, N., additional, Golder, K., additional, Ackland, G.L., additional, Stephens, R.C.M., additional, Gallego-Paredes, L., additional, Reyes, A., additional, Gutierrez del Arroyo, A., additional, Raj, A., additional, R Lifford, R., additional, Melo, M., additional, Mamdani, M., additional, Hillis, G., additional, and Wijeysundera, H.C., additional

Published
2021
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6. Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study

Author

Wijeysundera, Duminda N., primary, Beattie, W. Scott, additional, Hillis, Graham S., additional, Abbott, Tom E.F., additional, Shulman, Mark A., additional, Ackland, Gareth L., additional, Mazer, C. David, additional, Myles, Paul S., additional, Pearse, Rupert M., additional, Cuthbertson, Brian H., additional, Myles, P.S., additional, Shulman, M.A., additional, Wallace, S., additional, Farrington, C., additional, Thompson, B., additional, Ellis, M., additional, Borg, B., additional, Kerridge, R.K., additional, Douglas, J., additional, Brannan, J., additional, Pretto, J., additional, Godsall, M.G., additional, Beauchamp, N., additional, Allen, S., additional, Kennedy, A., additional, Wright, E., additional, Malherbe, J., additional, Ismail, H., additional, Riedel, B., additional, Melville, A., additional, Sivakumar, H., additional, Murmane, A., additional, Kenchington, K., additional, Kirabiyik, Y., additional, Gurunathan, U., additional, Stonell, C., additional, Brunello, K., additional, Steele, K., additional, Tronstad, O., additional, Masel, P., additional, Dent, A., additional, Smith, E., additional, Bodger, A., additional, Abolfathi, M., additional, Sivalingam, P., additional, Hall, A., additional, Painter, T.W., additional, Macklin, S., additional, Elliott, A., additional, Carrera, A.M., additional, Terblanche, N.C.S., additional, Pitt, S., additional, Samuels, J., additional, Wilde, C., additional, Leslie, K., additional, MacCormick, A., additional, Bramley, D., additional, Southcott, A.M., additional, Grant, J., additional, Taylor, H., additional, Bates, S., additional, Towns, M., additional, Tippett, A., additional, Marshall, F., additional, Mazer, C.D., additional, Kunasingam, J., additional, Yagnik, A., additional, Crescini, C., additional, Yagnik, S., additional, McCartney, C.J.L., additional, Choi, S., additional, Somascanthan, P., additional, Flores, K., additional, Wijeysundera, D.N., additional, Beattie, W.S., additional, Karkouti, K., additional, Clarke, H.A., additional, Jerath, A., additional, McCluskey, S.A., additional, Wasowicz, M., additional, Granton, J.T., additional, Day, L., additional, Pazmino-Canizares, J., additional, Oh, P., additional, Belliard, R., additional, Lee, L., additional, Dobson, K., additional, Chan, V., additional, Brull, R., additional, Ami, N., additional, Stanbrook, M., additional, Hagen, K., additional, Campbell, D., additional, Short, T., additional, Van Der Westhuizen, J., additional, Higgie, K., additional, Lindsay, H., additional, Jang, R., additional, Wong, C., additional, Mcallister, D., additional, Ali, M., additional, Kumar, J., additional, Waymouth, E., additional, Kim, C., additional, Dimech, J., additional, Lorimer, M., additional, Tai, J., additional, Miller, R., additional, Sara, R., additional, Collingwood, A., additional, Olliff, S., additional, Gabriel, S., additional, Houston, H., additional, Dalley, P., additional, Hurford, S., additional, Hunt, A., additional, Andrews, L., additional, Navarra, L., additional, Jason-Smith, A., additional, Thompson, H., additional, McMillan, N., additional, Back, G., additional, Croal, B.L., additional, Lum, M., additional, Martin, D., additional, James, S., additional, Filipe, H., additional, Pinto, M., additional, Kynaston, S., additional, Pearse, R.M., additional, Abbott, T.E.F., additional, Phull, M., additional, Beilstein, C., additional, Bodger, P., additional, Everingham, K., additional, Hu, Y., additional, Niebrzegowska, E., additional, Corriea, C., additional, Creary, T., additional, Januszewska, M., additional, Ahmad, T., additional, Whalley, J., additional, Haslop, R., additional, McNeil, J., additional, Brown, A., additional, MacDonald, N., additional, Pakats, M., additional, Greaves, K., additional, Jhanji, S., additional, Raobaikady, R., additional, Black, E., additional, Rooms, M., additional, Lawrence, H., additional, Koutra, M., additional, Pirie, K., additional, Gertsman, M., additional, Jack, S., additional, Celinski, M., additional, Levett, D., additional, Edwards, M., additional, Salmon, K., additional, Bolger, C., additional, Loughney, L., additional, Seaward, L., additional, Collins, H., additional, Tyrell, B., additional, Tantony, N., additional, Golder, K., additional, Ackland, G.L., additional, Stephens, R.C.M., additional, Gallego-Paredes, L., additional, Reyes, A., additional, Gutierrez del Arroyo, A., additional, Raj, A., additional, Lifford, R., additional, Cuthbertson, B.H., additional, Torres, E., additional, Ambosta, A., additional, Melo, M., additional, Mamdani, M., additional, Thorpe, K.E., additional, Grocott, M.P.W., additional, Hillis, G., additional, and Wijeysundera, H.C., additional

Published
2020
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7. A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: A secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study

Author

Riedel, B., Li, M.H-G, Lee, C.H.A., Ismail, H., Cuthbertson, B.H., Wijeysundera, D.N., Ho, K.M., Wallace, S., Thompson, B., Ellis, M., Borg, B., Kerridge, R.K., Douglas, J., Brannan, J., Pretto, J., Godsall, M.G., Beauchamp, N., Allen, S., Kennedy, A., Wright, E., Malherbe, J., Melville, A., Sivakumar, H., Murmane, A., Kenchington, K., Kirabiyik, Y., Gurunathan, U., Stonell, C., Brunello, K., Steele, K., Tronstad, O., Masel, P., Dent, A., Smith, E., Bodger, A., Abolfathi, M., Sivalingam, P., Hall, A., Painter, T.W., Macklin, S., Elliott, A., Carrera, A.M., Terblanche, N.C.S., Pitt, S., Samuels, J., Wilde, C., Leslie, K., MacCormick, A., Bramley, D., Southcott, A.M., Grant, J., Taylor, H., Bates, S., Towns, M., Tippett, A., Marshall, F., Mazer, C.D., Kunasingam, J., Yagnik, A., Crescini, C., Yagnik, S., McCartney, C.J.L., Choi, S., Somascanthan, P., Flores, K., Au, S., Beattie, W.S., Karkouti, K., Clarke, H.A., Jerath, A., McCluskey, S.A., Wasowicz, M., Day, L., Pazmino-Canizares, J., Oh, P., Belliard, R., Lee, L., Dobson, K., Chan, V., Brull, R., Ami, N., Stanbrook, M., Hagen, K., Campbell, D., Short, T., Van Der Westhuizen, J., Higgie, J.K., Lindsay, H., Jang, R., Wong, C., Mcallister, D., Ali, M., Kumar, J., Waymouth, E., Kim, C., Dimech, J., Lorimer, M., Tai, J., Miller, R., Sara, R., Collingwood, A., Olliff, S., Gabriel, S., Houston, H., Dalley, P., Hurford, S., Hunt, A., Andrews, L., Navarra, L., Jason-Smith, A., Thompson, H., McMillan, N., Back, G., Lum, M., Martin, D., S James, S., Filipe, H., Pinto, M., Kynaston, S., Phull, M., Beilstein, C., Bodger, P., Everingham, K., Hu, Y., Niebrzegowska, E., Corriea, C., Creary, T., Januszewska, M., Ahmad, T., Whalley, J., Haslop, R., McNeil, J., Brown, A., MacDonald, N., Pakats, M., Greaves, K., Jhanji, S., Raobaikady, R., Black, E., Rooms, M., Lawrence, H., Koutra, M., Pirie, K., Gertsman, M., Jack, S., Celinski, M., Levett, D., Edwards, M., Salmon, K., Bolger, C., Loughney, L., Seaward, L., Collins, H., Tyrell, B., Tantony, N., Golder, K., Ackland, G.L., Stephens, R.C.M., Gallego-Paredes, L., Reyes, A., Gutierrez del Arroyo, A., Raj, A., Lifford, R., Melo, M., Mamdani, M., Hillis, G., Wijeysundera, H.C., Riedel, B., Li, M.H-G, Lee, C.H.A., Ismail, H., Cuthbertson, B.H., Wijeysundera, D.N., Ho, K.M., Wallace, S., Thompson, B., Ellis, M., Borg, B., Kerridge, R.K., Douglas, J., Brannan, J., Pretto, J., Godsall, M.G., Beauchamp, N., Allen, S., Kennedy, A., Wright, E., Malherbe, J., Melville, A., Sivakumar, H., Murmane, A., Kenchington, K., Kirabiyik, Y., Gurunathan, U., Stonell, C., Brunello, K., Steele, K., Tronstad, O., Masel, P., Dent, A., Smith, E., Bodger, A., Abolfathi, M., Sivalingam, P., Hall, A., Painter, T.W., Macklin, S., Elliott, A., Carrera, A.M., Terblanche, N.C.S., Pitt, S., Samuels, J., Wilde, C., Leslie, K., MacCormick, A., Bramley, D., Southcott, A.M., Grant, J., Taylor, H., Bates, S., Towns, M., Tippett, A., Marshall, F., Mazer, C.D., Kunasingam, J., Yagnik, A., Crescini, C., Yagnik, S., McCartney, C.J.L., Choi, S., Somascanthan, P., Flores, K., Au, S., Beattie, W.S., Karkouti, K., Clarke, H.A., Jerath, A., McCluskey, S.A., Wasowicz, M., Day, L., Pazmino-Canizares, J., Oh, P., Belliard, R., Lee, L., Dobson, K., Chan, V., Brull, R., Ami, N., Stanbrook, M., Hagen, K., Campbell, D., Short, T., Van Der Westhuizen, J., Higgie, J.K., Lindsay, H., Jang, R., Wong, C., Mcallister, D., Ali, M., Kumar, J., Waymouth, E., Kim, C., Dimech, J., Lorimer, M., Tai, J., Miller, R., Sara, R., Collingwood, A., Olliff, S., Gabriel, S., Houston, H., Dalley, P., Hurford, S., Hunt, A., Andrews, L., Navarra, L., Jason-Smith, A., Thompson, H., McMillan, N., Back, G., Lum, M., Martin, D., S James, S., Filipe, H., Pinto, M., Kynaston, S., Phull, M., Beilstein, C., Bodger, P., Everingham, K., Hu, Y., Niebrzegowska, E., Corriea, C., Creary, T., Januszewska, M., Ahmad, T., Whalley, J., Haslop, R., McNeil, J., Brown, A., MacDonald, N., Pakats, M., Greaves, K., Jhanji, S., Raobaikady, R., Black, E., Rooms, M., Lawrence, H., Koutra, M., Pirie, K., Gertsman, M., Jack, S., Celinski, M., Levett, D., Edwards, M., Salmon, K., Bolger, C., Loughney, L., Seaward, L., Collins, H., Tyrell, B., Tantony, N., Golder, K., Ackland, G.L., Stephens, R.C.M., Gallego-Paredes, L., Reyes, A., Gutierrez del Arroyo, A., Raj, A., Lifford, R., Melo, M., Mamdani, M., Hillis, G., and Wijeysundera, H.C.

Abstract

Background Accurate assessment of functional capacity, a predictor of postoperative morbidity and mortality, is essential to improving surgical planning and outcomes. We assessed if all 12 items of the Duke Activity Status Index (DASI) were equally important in reflecting exercise capacity. Methods In this secondary cross-sectional analysis of the international, multicentre Measurement of Exercise Tolerance before Surgery (METS) study, we assessed cardiopulmonary exercise testing and DASI data from 1455 participants. Multivariable regression analyses were used to revise the DASI model in predicting an anaerobic threshold (AT) >11 ml kg −1 min −1 and peak oxygen consumption (VO 2 peak) >16 ml kg −1 min −1, cut-points that represent a reduced risk of postoperative complications. Results Five questions were identified to have dominance in predicting AT>11 ml kg −1 min −1 and VO 2 peak>16 ml.kg −1min −1. These items were included in the M-DASI-5Q and retained utility in predicting AT>11 ml.kg −1.min −1 (area under the receiver-operating-characteristic [AUROC]-AT: M-DASI-5Q=0.67 vs original 12-question DASI=0.66) and VO 2 peak (AUROC-VO2 peak: M-DASI-5Q 0.73 vs original 12-question DASI 0.71). Conversely, in a sensitivity analysis we removed one potentially sensitive question related to the ability to have sexual relations, and the ability of the remaining four questions (M-DASI-4Q) to predict an adequate functional threshold remained no worse than the original 12-question DASI model. Adding a dynamic component to the M-DASI-4Q by assessing the chronotropic response to exercise improved its ability to discriminate between those with VO 2 peak>16 ml.kg −1.min −1 and VO 2 peak<16 ml.kg −1.min −1. Conclusions The M-DASI provides a simple screening tool for further preoperative evaluation, including with cardiopulmonary exercise testing, to guide perioperative management.

Published
2020

8. Association of preoperative anaemia with cardiopulmonary exercise capacity and postoperative outcomes in noncardiac surgery: a substudy of the Measurement of Exercise Tolerance before Surgery (METS) Study

Author

Bartoszko, J., primary, Thorpe, K.E., additional, Laupacis, A., additional, Wijeysundera, D.N., additional, Myles, P.S., additional, Shulman, M.A., additional, Wallace, S., additional, Farrington, C., additional, Thompson, B., additional, Ellis, M., additional, Borg, B., additional, Kerridge, R.K., additional, Douglas, J., additional, Brannan, J., additional, Pretto, J., additional, Godsall, M.G., additional, Beauchamp, N., additional, Allen, S., additional, Kennedy, A., additional, Wright, E., additional, Malherbe, J., additional, Ismail, H., additional, Riedel, B., additional, Melville, A., additional, Sivakumar, H., additional, Murmane, A., additional, Kenchington, K., additional, Kirabiyik, Y., additional, Gurunathan, U., additional, Stonell, C., additional, Brunello, K., additional, Steele, K., additional, Tronstad, O., additional, Masel, P., additional, Dent, A., additional, Smith, E., additional, Bodger, A., additional, Abolfathi, M., additional, Sivalingam, P., additional, Hall, A., additional, Painter, T.W., additional, Macklin, S., additional, Elliott, A., additional, Carrera, A.M., additional, Terblanche, N.C.S., additional, Pitt, S., additional, Samuels, J., additional, Wilde, C., additional, Leslie, K., additional, MacCormick, A., additional, Bramley, D., additional, Southcott, A.M., additional, Grant, J., additional, Taylor, H., additional, Bates, S., additional, Towns, M., additional, Tippett, A., additional, Marshall, F., additional, Mazer, C.D., additional, Kunasingam, J., additional, Yagnik, A., additional, Crescini, C., additional, Yagnik, S., additional, McCartney, C.J.L., additional, Choi, S., additional, Somascanthan, P., additional, Flores, K., additional, Beattie, W.S., additional, Karkouti, K., additional, Clarke, H.A., additional, Jerath, A., additional, McCluskey, S.A., additional, Wasowicz, M., additional, Granton, J.T., additional, Day, L., additional, Pazmino-Canizares, J., additional, Oh, P., additional, Belliard, R., additional, Lee, L., additional, Dobson, K., additional, Chan, V., additional, Brull, R., additional, Ami, N., additional, Stanbrook, M., additional, Hagen, K., additional, Campbell, D., additional, Short, T., additional, Van Der Westhuizen, J., additional, Higgie, K., additional, Lindsay, H., additional, Jang, R., additional, Wong, C., additional, Mcallister, D., additional, Ali, M., additional, Kumar, J., additional, Waymouth, E., additional, Kim, C., additional, Dimech, J., additional, Lorimer, M., additional, Tai, J., additional, Miller, R., additional, Sara, R., additional, Collingwood, A., additional, Olliff, S., additional, Gabriel, S., additional, Houston, H., additional, Dalley, P., additional, Hurford, S., additional, Hunt, A., additional, Andrews, L., additional, Navarra, L., additional, Jason-Smith, A., additional, Thompson, H., additional, McMillan, N., additional, Back, G., additional, Croal, B.L., additional, Lum, M., additional, Martin, D., additional, James, S., additional, Filipe, H., additional, Pinto, M., additional, Kynaston, S., additional, Pearse, R.M., additional, Abbott, T.E.F., additional, Phull, M., additional, Beilstein, C., additional, Bodger, P., additional, Everingham, K., additional, Hu, Y., additional, Niebrzegowska, E., additional, Corriea, C., additional, Creary, T., additional, Januszewska, M., additional, Ahmad, T., additional, Whalley, J., additional, Haslop, R., additional, McNeil, J., additional, Brown, A., additional, MacDonald, N., additional, Pakats, M., additional, Greaves, K., additional, Jhanji, S., additional, Raobaikady, R., additional, Black, E., additional, Rooms, M., additional, Lawrence, H., additional, Koutra, M., additional, Pirie, K., additional, Gertsman, M., additional, Jack, S., additional, Celinski, M., additional, Levett, D., additional, Edwards, M., additional, Salmon, K., additional, Bolger, C., additional, Loughney, L., additional, Seaward, L., additional, Collins, H., additional, Tyrell, B., additional, Tantony, N., additional, Golder, K., additional, Ackland, G.L., additional, Gallego-Paredes, L., additional, Reyes, A., additional, Gutierrez del Arroyo, A., additional, Raj, A., additional, Lifford, R., additional, Cuthbertson, B.H., additional, Torres, E., additional, Ambosta, A., additional, Melo, M., additional, Mamdani, M., additional, Grocott, M.P.W., additional, Hillis, G., additional, and Wijeysundera, H.C., additional

Published
2019
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9. Heart rate recovery and morbidity after noncardiac surgery: Planned secondary analysis of two prospective, multi-centre, blinded observational studies

Author

Bianchi, C, Ackland, GL, Abbott, TEF, Minto, G, Clark, M, Owen, T, Prabhu, P, May, SM, Reynolds, JA, Cuthbertson, BH, Wijesundera, D, Pearse, RM, Myles, PS, Shulman, MA, Wallace, S, Farrington, C, Thompson, B, Ellis, M, Borg, B, Kerridge, RK, Douglas, J, Brannan, J, Pretto, J, Godsall, MG, Beauchamp, N, Allen, S, Kennedy, A, Wright, E, Malherbe, J, Ismail, H, Riedel, B, Melville, A, Sivakumar, H, Murmane, A, Kenchington, K, Kirabiyik, Y, Gurunathan, U, Stonell, C, Brunello, K, Steele, K, Tronstad, O, Masel, P, Dent, A, Smith, E, Bodger, A, Abolfathi, M, Sivalingam, P, Hall, A, Painter, TW, Macklin, S, Elliott, A, Carrera, AM, Terblanche, NCS, Pitt, S, Samuels, J, Wilde, C, Leslie, K, MacCormick, A, Bramley, D, Southcott, AM, Grant, J, Taylor, H, Bates, S, Towns, M, Tippett, A, Marshall, F, Mazer, CD, Kunasingam, J, Yagnik, A, Crescini, C, Yagnik, S, McCartney, CJL, Choi, S, Somascanthan, P, Flores, K, Wijeysundera, DN, Beattie, WS, Karkouti, K, Clarke, HA, Jerath, A, McCluskey, SA, Wasowicz, M, Granton, JT, Day, L, Pazmino-Canizares, J, Oh, P, Belliard, R, Lee, L, Dobson, K, Chan, V, Brull, R, Ami, N, Stanbrook, M, Hagen, K, Campbell, D, Short, T, Van Der Westhuizen, J, Higgie, K, Lindsay, H, Jang, R, Wong, C, Mcallister, D, Ali, M, Kumar, J, Waymouth, E, Kim, C, Dimech, J, Lorimer, M, Tai, J, Miller, R, Sara, R, Collingwood, A, Olliff, S, Gabriel, S, Houston, H, Dalley, P, Hurford, S, Hunt, A, Andrews, L, Navarra, L, Jason-Smith, A, Thompson, H, McMillan, N, Back, G, Croal, BL, Lum, M, Martin, D, James, S, Filipe, H, Pinto, M, Kynaston, S, Phull, M, Beilstein, C, Bodger, P, Everingham, K, Hu, Y, Niebrzegowska, E, Corriea, C, Creary, T, Januszewska, M, Ahmad, T, Whalley, J, Haslop, R, McNeil, J, Brown, A, MacDonald, N, Pakats, M, Greaves, K, Jhanji, S, Raobaikady, R, Black, E, Rooms, M, Lawrence, H, Koutra, M, Pirie, K, Gertsman, M, Jack, S, Celinski, M, Levett, D, Edwards, M, Salmon, K, Bolger, C, Loughney, L, Seaward, L, Collins, H, Tyrell, B, Tantony, N, Golder, K, Stephens, RCM, Gallego-Paredes, L, Reyes, A, del Arroyo, AG, Raj, A, Lifford, R, King, A, Pollak, C, Williams, C, Patrick, A, West, C, Vickers, E, Green, R, Jones, A, Otto, J, Lach, A, Whittle, J, Paredes, LG, Toner, A, Williams, A, Pradhu, P, Hull, D, Montague, L, Bianchi, C, Ackland, GL, Abbott, TEF, Minto, G, Clark, M, Owen, T, Prabhu, P, May, SM, Reynolds, JA, Cuthbertson, BH, Wijesundera, D, Pearse, RM, Myles, PS, Shulman, MA, Wallace, S, Farrington, C, Thompson, B, Ellis, M, Borg, B, Kerridge, RK, Douglas, J, Brannan, J, Pretto, J, Godsall, MG, Beauchamp, N, Allen, S, Kennedy, A, Wright, E, Malherbe, J, Ismail, H, Riedel, B, Melville, A, Sivakumar, H, Murmane, A, Kenchington, K, Kirabiyik, Y, Gurunathan, U, Stonell, C, Brunello, K, Steele, K, Tronstad, O, Masel, P, Dent, A, Smith, E, Bodger, A, Abolfathi, M, Sivalingam, P, Hall, A, Painter, TW, Macklin, S, Elliott, A, Carrera, AM, Terblanche, NCS, Pitt, S, Samuels, J, Wilde, C, Leslie, K, MacCormick, A, Bramley, D, Southcott, AM, Grant, J, Taylor, H, Bates, S, Towns, M, Tippett, A, Marshall, F, Mazer, CD, Kunasingam, J, Yagnik, A, Crescini, C, Yagnik, S, McCartney, CJL, Choi, S, Somascanthan, P, Flores, K, Wijeysundera, DN, Beattie, WS, Karkouti, K, Clarke, HA, Jerath, A, McCluskey, SA, Wasowicz, M, Granton, JT, Day, L, Pazmino-Canizares, J, Oh, P, Belliard, R, Lee, L, Dobson, K, Chan, V, Brull, R, Ami, N, Stanbrook, M, Hagen, K, Campbell, D, Short, T, Van Der Westhuizen, J, Higgie, K, Lindsay, H, Jang, R, Wong, C, Mcallister, D, Ali, M, Kumar, J, Waymouth, E, Kim, C, Dimech, J, Lorimer, M, Tai, J, Miller, R, Sara, R, Collingwood, A, Olliff, S, Gabriel, S, Houston, H, Dalley, P, Hurford, S, Hunt, A, Andrews, L, Navarra, L, Jason-Smith, A, Thompson, H, McMillan, N, Back, G, Croal, BL, Lum, M, Martin, D, James, S, Filipe, H, Pinto, M, Kynaston, S, Phull, M, Beilstein, C, Bodger, P, Everingham, K, Hu, Y, Niebrzegowska, E, Corriea, C, Creary, T, Januszewska, M, Ahmad, T, Whalley, J, Haslop, R, McNeil, J, Brown, A, MacDonald, N, Pakats, M, Greaves, K, Jhanji, S, Raobaikady, R, Black, E, Rooms, M, Lawrence, H, Koutra, M, Pirie, K, Gertsman, M, Jack, S, Celinski, M, Levett, D, Edwards, M, Salmon, K, Bolger, C, Loughney, L, Seaward, L, Collins, H, Tyrell, B, Tantony, N, Golder, K, Stephens, RCM, Gallego-Paredes, L, Reyes, A, del Arroyo, AG, Raj, A, Lifford, R, King, A, Pollak, C, Williams, C, Patrick, A, West, C, Vickers, E, Green, R, Jones, A, Otto, J, Lach, A, Whittle, J, Paredes, LG, Toner, A, Williams, A, Pradhu, P, Hull, D, and Montague, L

Abstract

BACKGROUND: Impaired cardiac vagal function, quantified preoperatively as slower heart rate recovery (HRR) after exercise, is independently associated with perioperative myocardial injury. Parasympathetic (vagal) dysfunction may also promote (extra-cardiac) multi-organ dysfunction, although perioperative data are lacking. Assuming that cardiac vagal activity, and therefore heart rate recovery response, is a marker of brainstem parasympathetic dysfunction, we hypothesized that impaired HRR would be associated with a higher incidence of morbidity after noncardiac surgery. METHODS: In two prospective, blinded, observational cohort studies, we established the definition of impaired vagal function in terms of the HRR threshold that is associated with perioperative myocardial injury (HRR ≤ 12 beats min-1 (bpm), 60 seconds after cessation of cardiopulmonary exercise testing. The primary outcome of this secondary analysis was all-cause morbidity three and five days after surgery, defined using the Post-Operative Morbidity Survey. Secondary outcomes of this analysis were type of morbidity and time to become morbidity-free. Logistic regression and Cox regression tested for the association between HRR and morbidity. Results are presented as odds/hazard ratios [OR or HR; (95% confidence intervals). RESULTS: 882/1941 (45.4%) patients had HRR≤12bpm. All-cause morbidity within 5 days of surgery was more common in 585/822 (71.2%) patients with HRR≤12bpm, compared to 718/1119 (64.2%) patients with HRR>12bpm (OR:1.38 (1.14-1.67); p = 0.001). HRR≤12bpm was associated with more frequent episodes of pulmonary (OR:1.31 (1.05-1.62);p = 0.02)), infective (OR:1.38 (1.10-1.72); p = 0.006), renal (OR:1.91 (1.30-2.79); p = 0.02)), cardiovascular (OR:1.39 (1.15-1.69); p<0.001)), neurological (OR:1.73 (1.11-2.70); p = 0.02)) and pain morbidity (OR:1.38 (1.14-1.68); p = 0.001) within 5 days of surgery. CONCLUSIONS: Multi-organ dysfunction is more common in surgical patients with cardiac vagal dys

Published
2019

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