10: Is a subjective assessment of functional capacity predictive of perioperative complications?

We investigate the claim that a subjective assessment is an accurate way to measure functional capacity. We also explore whether self-reported ability to climb two flights of stairs is the best subjective method to assess functional capacity and whether exercise tolerance greater than or equal to 4 metabolic equivalents predicts the risk of perioperative complications in any major non-cardiac surgery. Our guests today are Dr. Elisa Walsh and Dr. Laurie Shapiro of the Massachusetts General Hospital.  Full show notes available at depthofanesthesia.com.  Connect with us @DepthAnesthesia on Twitter or depthofanesthesia@gmail.com. Thanks for listening! Please rate us on iTunes and share with your colleagues.  Music by Stephen Campbell, MD.  __ References Wijeysundera et al. Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study. Lancet. 2018; 391: p2631-2640. Fleisher et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 130: e278-e333. Hlatky et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol. 1989 Sep 15;64(10):651-4. Wang et al. Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N Engl J Med. 2004;350(7):655. Kistrop et al. N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. JAMA. 2005;293(13):1609. Struthers et al. The potential to improve primary prevention in the future by using BNP/N-BNP as an indicator of silent ‘pancardiac’ target organ damage. European Heart Journal, Volume 28, Issue 14, July 2007, Pages 1678–1682 Carliner et al. Routine preoperative exercise testing patients undergoing major noncardiac surgery. Am J Cardiol 1985;56;51-58. Sgura et al. Supine exercise capacity identifies patients at low risk for perioperative cardiovascular events and predicts long-term survival. Am J Medicin 2000; 108. Kistorp et al. N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. JAMA. 2005;293(13):1609. Reilly et al. Self-reported exercise tolerance and the risk of serious perioperative complications. Arch Intern Med. 1999 Oct 11;159(18):2185-92. Melon et al. Validated questionnaire vs physicians' judgment to estimate preoperative exercise capacity. JAMA Intern Med. 2014 Sep;174(9):1507-8. Weinstein et al. Comparison of Preoperative Assessment of Patient's Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing. Anesthesiol Res Pract. 2018; 2018: 5912726. Ryding et al. Prognostic Value of Brain Natriuretic Peptide in Noncardiac Surgery: A Meta-analysis. Anesthesiology. 8 2009, Vol.111, 311-319. Wright et al. Examining Risk: A Systematic Review of Perioperative Cardiac Risk Prediction Indices. Mayo Clin Proc. 2019. Wiklund RA, Stein HD, Rosenbaum SH. Activities of daily living and cardiovascular complications following elective, noncardiac surgery. Yale J Biol Med 2001; 74: 75–87 Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett Jr DR, Tudor-Locke C, Greer JL, Vezina J, Whitt-   Glover MC, Leon AS. 2011 Compendium of Physical Activities: a second update of codes and MET values. Medicine and Science in Sports and Exercise, 2011;43(8):1575-1581. __ By listening to this podcast, you agree not to use information as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Opinions expressed are solely those of the host and guests and do not express the views or opinions of Massachusetts General Hospital.

Om Podcasten

Depth of Anesthesia is a podcast that critically explores dogmatic practices (we call them claims) in anesthesiology. Join us as we explore the literature around the latest clinical controversies!