Published: Patient-reported questionnaires to preoperatively identify high-risk surgical patients

Hits: 50
  • Publication status: Gepubliceerd
  • Type of study: Clinimetrics
  • Journal: Springer Open - Langenbeck's Archives of Surgery

  • Meijer, R. ORCID iD

    Cate ten, D. ORCID iD

    Bongers, B. ORCID iD

    Regis, M. ORCID iD

    Savelberg, H. ORCID iD

    Slooter, G. ORCID iD

    Janssen, S. ORCID iD

    Hooff van, M. ORCID iD

    Schep, G. ORCID iD

  • Affiliations: Eindhoven University of Technology, Maastricht University, Maastricht University Medical Center, Máxima Medical Centre
  • Population: Healthy Subjects, Oncology, Cardiac, Pulmonary
  • DOI: https://doi.org/10.1007/s00423-024-03560-0
  • PMID: 39633203
  • BibTex: 
      
@article{Meijer2024PreOp,
  author  = {Renske Meijer and David W. G. ten Cate and Bart C. Bongers and Marta Regis and Hans H. C. M. Savelberg and Gerrit D. Slooter and Stef Janssen and Martijn van Hooff and Goof Schep},
  title   = {Patient-reported questionnaires to preoperatively identify high-risk surgical patients},
  journal = {Langenbeck's Archives of Surgery},
  volume  = {409},
  pages   = {Article number: 372},
  year    = {2024},
  doi     = {10.1007/s00423-024-03560-0},
  url     = {https://link.springer.com/article/10.1007/s00423-024-03560-0}
}

Purpose: Low cardiorespiratory fitness (CRF) increases the risk of postoperative morbidity and mortality following major surgery. Assessing CRF preoperatively, by measuring peak oxygen uptake (VO2peak) during cardiopulmonary exercise testing (CPET), is valuable yet not widely available. This study aimed to assess whether questionnaires could be used preoperatively to identify high-risk surgical patients.

Methods: Healthy participants and patients who underwent CPET completed the FitMáx, Duke Activity Status Index (DASI), the modified 4-questions DASI (M-DASI-4Q), Veterans-Specific Activity Questionnaire (VSAQ), and Metabolic Equivalents of Task (MET) questionnaire. Questionnaire-VO2peak was compared with CPET-VO2peak. Overall performance of the questionnaires was assessed by the area under the curve (AUC) of receiver operating characteristic (ROC) curves. Furthermore, corresponding to the Youden index or pre-specified levels, sensitivity, specificity, and predictive values were determined.

Results: In total, 361 participants were included. All questionnaires showed high AUC values to identify high-risk patients, defined on the basis of CPET-VO2peak thresholds. FitMáx and VSAQ demonstrated superior results compared to the other questionnaires. Based on the Youden index, the optimal questionnaire-VO2peak cut-off values were 20.6, 21.3, and 26.1 ml·kg-1·min-1 for the FitMáx and 16.3, 18.2, and 20.4 ml·kg-1·min-1 for the VSAQ corresponding to the VO2peak thresholds 16.0, 18.2 and 24.5 ml·kg-1·min-1 respectively.

Conclusion: The ability to identify high-risk surgical patients preoperatively (defined by the CPET-VO2peak thresholds) by the FitMáx and the VSAQ indicates that they could be used to identify high-risk surgical patients. Patients with a poor predicted VO2peak ≤ 21.3 and ≤ 18.2 ml·kg-1·min-1, respectively for FitMáx and VSAQ, should be referred to formal preoperative (cardiopulmonary) exercise testing.