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Assessment of functional capacity is central to perioperative cardiovascular evaluation and management of patients undergoing non-cardiac surgery. Impaired functional capacity is a well-accepted predictor of postoperative morbidity and mortality. Therefore, preoperative risk assessment of functional capacity may improve surgical outcomes by optimisation of risks by pre-habilitation, improving perioperative management and postoperative rehabilitation.
The Duke Activity Status Index (DASI) uses 12 questions to assess a person’s ability to perform activities of daily living. It is a simple and inexpensive surrogate measure estimating peak oxygen consumption by a total sum of responses to these 12 questions. The DASI score has been found to be associated with improved ability to predict a composite of myocardial infarction or death within 30 days after surgery. In comparison, subjective clinician assessment of metabolic equivalents (METS) of < 4 had a sensitivity of < 20%. A subsequent simplified, recalibrated version of the DASI (M-DASI 4q) with 4 questions was accurate as a screening tool to distinguish patients who have adequate functional capacity from those who might benefit from further testing and pre-habilitation.
- Able to climb a flight of stairs or walk up a hill?
- Able to do heavy work around the house (lifting and moving heavy furniture)?
- Able to do yard work (raking leaves or pushing a mower)?
- Able to participate in strenuous sports (swimming, tennis, football, skiing)?