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

PurposeLow 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.MethodsHealthy participants and patients who underwent CPET completed the FitM & aacute;x, 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.ResultsIn total, 361 participants were included. All questionnaires showed high AUC values to identify high-risk patients, defined on the basis of CPET-VO2peak thresholds. FitM & aacute;x 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<middle dot>kg-1<middle dot>min-1 for the FitM & aacute;x and 16.3, 18.2, and 20.4 ml<middle dot>kg-1<middle dot>min-1 for the VSAQ corresponding to the VO2peak thresholds 16.0, 18.2 and 24.5 ml<middle dot>kg-1<middle dot>min-1 respectively.ConclusionThe ability to identify high-risk surgical patients preoperatively (defined by the CPET-VO2peak thresholds) by the FitM & aacute;x 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<middle dot>kg-1<middle dot>min-1, respectively for FitM & aacute;x and VSAQ, should be referred to formal preoperative (cardiopulmonary) exercise testing.Trial registrationThe study was registered as NL-OMON23304 in the Overview of Medical Research in the Netherlands, retrospectively at 28-04-2020.