Assessing fitness for surgery: a comparison of questionnaire, incremental shuttle walk, and cardiopulmonary exercise testing in general surgical patients

Struthers, R. R.; Erasmus, P.; Holmes, K.; Warman, Paul; Collingwood, A.; Sneyd, J. R.

doi:10.1093/bja/aen310

Cited by 135 publications

(80 citation statements)

References 20 publications

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“…Cardiopulmonary exercise testing (CPET) provides an objective measurement of physiological fitness that predicts postoperative cardiorespiratory mortality and is superior to simple self-reported questionnaires or shuttle walk tests. 14,15 However, CPET and other similar tools are expensive resources and not available universally. In our institution, we now strive to ensure that these patients are routinely assessed preoperatively by a consultant anaesthetist but, again, this requires additional resources at a time when financial pressures on the NHS are ever-increasing.…”

Section: Discussionmentioning

confidence: 99%

Colorectal cancer outcomes in patients aged over 85 years

Watts

Bull

et al. 2016

annals

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INTRODUCTIONThe prevalence of colorectal cancer is increasing in the elderly. We examined the treatment and outcomes in our institution of patients aged over 85 years with proven colorectal adenocarcinoma. METHODS One hundred and five patients were identified and stratified by treatment received: curative surgery (CS), other treatments (OT) or best supportive care (BSC). Data on demographics, staging, treatment and survival was collected and analysed. RESULTS Forty two patients received CS, 36 OT and 27 BSC. While the treated groups (CS and OT) were similar in terms of age (p=0.35) and staging (p=0.16), BSC patients were significantly older and had higher stage disease (p<0.01). Survival was significantly poorer among BSC patients, at a mean of 9.7 months (95% confidence interval [CI] 4.7-14.7) versus 41.6 months (95% CI 32.5-50.7) and OT 27.3 months (95% CI 20.4-34.1) for the CS and OT groups (p<0.001). There was no significant survival difference between CS and OT groups within 2 years of treatment (p=0.12). Thereafter, OT patients had a very similar 5-year survival to that of the BSC group, at 13% versus 43% in CS patients (p<0.001). CONCLUSIONS These data suggest that, up to 2 years following treatment, the risks of resectional surgery for colorectal cancer may neutralise any benefit. However, those that survive beyond this period show improvements. The challenge of improving patient selection is most acute in the growing ageing population, and highlights the current focus on presenting all treatment options to 'a reasonable patient'.

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Section: Discussionmentioning

confidence: 99%

Colorectal cancer outcomes in patients aged over 85 years

Watts

Bull

et al. 2016

annals

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“…This finding was not unexpected, given that the DASI estimates • min −1 , or a DASI score > 11.6 can undergo cardiac surgery without the need for further investigation or changes in perioperative management. (27) A comparison between VO 2 as predicted by the DASI and the stages of COPD severity showed that greater severity translated to lower functional capacity, with statistically significant differences between stages II and IV. Had the number of patients with stage II, stage III, and stage IV COPD been higher, there might have been statistically significant differences among all stages.…”

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confidence: 95%

Adaptação cultural e avaliação da reprodutibilidade do Duke Activity Status Index para pacientes com DPOC no Brasil

et al. 2012

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Objective: To cross-culturally adapt the Duke Activity Status Index (DASI) for use in Brazil and evaluate the reproducibility of the new (Brazilian Portuguese-language) version. Methods: We selected stable patients with clinical and spirometric diagnosis of COPD. Initially, the DASI was translated into Brazilian Portuguese, and the cross-cultural adaptation was performed by an expert committee. Subsequently, 12 patients completed the questionnaire, so that their questions and difficulties could be identified and adjustments could be made. An independent translator back-translated the final version into English, which was then submitted to and approved by the original author. The final Brazilian Portuguese-language version of the DASI was applied to 50 patients at three distinct times. For the assessment of interobserver reproducibility, it was applied twice within a 30-min interval by two different interviewers. For the assessment of intraobserver reproducibility, it was applied again 15 days later by one of the interviewers. Results: The mean age of the patients was 62.3 ± 10.0 years, the mean FEV 1 was 45.2 ± 14.7% of the predicted value, and the mean body mass index was 26.8 ± 5.8 kg/m 2 . The intraclass correlation coefficients for intraobserver and interobserver reproducibility were 0.95 and 0.90, respectively. The correlations between the DASI and the Saint George's Respiratory Questionnaire (SGRQ) domains were all negative and statistically significant. The DASI correlated best with the SGRQ activity domain (r = −0.70), the total SGRQ score (r = −0.66), and the six-minute walk distance (r = 0.55). Conclusions: The Brazilian Portuguese-language version of the DASI is reproducible, fast, and simple, correlating well with the SGRQ.Keywords: Activities of daily living; Pulmonary disease, chronic obstructive; Reproducibility of results. ResumoObjetivo: Adaptar culturalmente e avaliar a reprodutibilidade do Duke Activity Status Index (DASI) para o português do Brasil. Métodos: Foram selecionados pacientes estáveis com diagnóstico clínico e espirométrico de DPOC. Inicialmente, o DASI foi traduzido para o português, e a adaptação cultural foi realizada por uma comissão de especialistas. Em seguida, o questionário foi aplicado em 12 pacientes para saber suas dúvidas e dificuldades, sendo realizadas as devidas adaptações. Um tradutor independente fez a tradução retrógrada, que foi submetida e aprovada pelo autor original. A versão final do DASI foi aplicada em 50 pacientes em dois momentos, com intervalo de 30 minutos (reprodutibilidade interobservador) e, num terceiro momento, após 15 dias (reprodutibilidade intraobservador). Resultados: A média de idade dos pacientes foi de 62,3 ± 10,0 anos, a média do VEF 1 foi de 45,2 ± 14,7% do valor previsto, e a do índice de massa corpórea foi de 26,8 ± 5,8 kg/m 2 . Os coeficientes de correlação intraclasse intraobservador e interobservador foram de 0,95 e 0,90, respectivamente. As correlações do DASI com todos os domínios do Saint George's Respiratory Questionnaire ...

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“…вседневную активность [8,15]. Значение максимального потребления кислорода (VO 2max ) рассчитывали на основе получен-ной информации из опросника по формуле:…”

Section: абсолютные и относительные противопоказания к выполнению карunclassified

“…Проблема побудила провести собствен-ное исследование с использованием как традиционных методов, не требующих спе-циального оборудования и оснащения, -6-минутного шагового теста (6-МШТ) [5,15], опросника повседневной активности университета Дюка с определением индек-са активности (Duke Activity Status Index -DASI) [8,15], так и нового функционального теста -кардиореспираторного нагрузоч-ного тестирования (КРНТ). Тест предостав-ляет диагностическую и прогностическую информацию на основании анализа функ-ционирования системы кровообращения и дыхания, что позволяет использовать его для прогнозирования послеоперационных осложнений [1,7,9,11,12].…”

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Predicting critical incidents development during elective surgery

et al. 2016

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Aim. The evaluate the possibility of predicting critical incidents development during elective surgery using Duke University activities of daily living questionnaire, a six-minute walk test, cardiopulmonary exercise testing.Methods. 36 patients who had undergone elective abdominal surgery were included in the study. To determine the functional state in preoperative period patients filled in Duke University activities of daily living questionnaire, performed a 6-minute walk test, cardiopulmonary exercise testing. Critical incidents analysis was conducted by E.A. Kazakova method (2005) at two stages: induction and maintenance of anesthesia. Using statistical methods the most informative indicators for predicting critical incidents were determined.Results. Logistic regression analysis demonstrated that only the anaerobic threshold and 6-minute walk test significantly contributed to predicting critical incidents. At the same time, ROC-analysis demonstrated the predictive value of using only the anaerobic threshold to determine the likelihood of critical incidents. It was found that this indicator threshold value is 10.85 ml/kg per minute with 100% sensitivity and 95% specificity. It is also proved that the patients’ subjective assessment leads to an overestimation of their functional state.Conclusion. Anaerobic threshold indicator determined by a cardiopulmonary exercise testing can be used as a criterion for predicting critical incidents development; reduction in the anaerobic threshold of less than 10.85 mL/kg per minute indicates the likelihood of critical incidents development with a high level of sensitivity and specificity.

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Assessing fitness for surgery: a comparison of questionnaire, incremental shuttle walk, and cardiopulmonary exercise testing in general surgical patients

Cited by 135 publications

References 20 publications

Colorectal cancer outcomes in patients aged over 85 years

Colorectal cancer outcomes in patients aged over 85 years

Adaptação cultural e avaliação da reprodutibilidade do Duke Activity Status Index para pacientes com DPOC no Brasil

Predicting critical incidents development during elective surgery

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