Association between the Duke Activity Status Index and complications after noncardiac surgery: A systematic review

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-03-17 DOI:10.1016/j.jclinane.2025.111808

Earlene Silvapulle , Jai Darvall , Anurika De Silva

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引用次数: 0

Abstract

Background

Individuals with poor functional capacity are at increased risk of perioperative complications. The Duke Activity Status Index (DASI) can ascertain the maximum physical activity achievable. However, the accuracy of the DASI score in identifying high-risk individuals is unclear. The objective of this systematic review was to determine the association between the DASI score and postoperative complications.

Methods

Studies conducted in adults undergoing elective or emergency noncardiac surgery were eligible. The search strategy used MEDLINE, EMBASE, EMCARE and Cochrane CENTRAL, from January 1st, 1988 to August 8th, 2024. Study quality and risk of bias were evaluated independently by two assessors.

Results

Of 5989 citations, nine studies (3100 participants) were included. The DASI score was associated with postoperative mortality (two studies, 732 participants) and postoperative cardiovascular complications (two studies, 2055 participants). The DASI score provided fair prediction of postoperative complications (three studies, area under the receiver operating characteristic curve range 0.71 to 0.75). Marked study heterogeneity precluded meta-analysis.

Discussion

This systematic review found an association between low DASI scores and cardiovascular complications, postoperative complications and mortality, and variable association between DASI scores and hospital length of stay. The major limitation to the evidence was the significant heterogeneity of study population, outcome definitions, DASI thresholds and cardiovascular endpoints.

Conclusion

Amongst adults undergoing noncardiac surgery, the DASI score is associated with postoperative complications, cardiovascular complications and mortality. Further research is required to identify a DASI threshold (or confirm the DASI threshold of 34) that accurately predicts postoperative complications, including major cardiac events.

Other

This systematic review was registered with PROSPERO on March 4th, 2024 (CRD42024331864). No funding was obtained for this review.

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Duke活动状态指数与非心脏手术后并发症之间的关系：一项系统综述

背景：功能能力差的患者围手术期并发症的风险增加。杜克活动状态指数（DASI）可以确定可实现的最大身体活动。然而，DASI评分在识别高危人群中的准确性尚不清楚。本系统综述的目的是确定DASI评分与术后并发症之间的关系。方法在接受选择性或紧急非心脏手术的成人中进行的研究符合条件。检索策略使用MEDLINE、EMBASE、EMCARE和Cochrane CENTRAL，检索时间为1988年1月1日至2024年8月8日。研究质量和偏倚风险由两名评估员独立评估。结果5989篇引用中，共纳入9篇研究（3100名受试者）。DASI评分与术后死亡率（两项研究，732名参与者）和术后心血管并发症（两项研究，2055名参与者）相关。DASI评分能较好地预测术后并发症（3项研究，受试者工作特征曲线下面积范围0.71 ~ 0.75）。显著的研究异质性排除了meta分析。本系统综述发现低DASI评分与心血管并发症、术后并发症和死亡率之间存在关联，DASI评分与住院时间之间存在可变关联。证据的主要限制是研究人群、结局定义、DASI阈值和心血管终点的显著异质性。结论在接受非心脏手术的成年人中，DASI评分与术后并发症、心血管并发症和死亡率相关。需要进一步的研究来确定DASI阈值（或确认DASI阈值为34），以准确预测包括主要心脏事件在内的术后并发症。该系统综述已于2024年3月4日在普洛斯彼罗注册（CRD42024331864）。本综述未获得经费。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.