Perioperative risk assessment - focus on functional capacity

被引:11
作者
Hanley, Ciara [1 ,2 ,3 ]
Wijeysundera, Duminda N. [1 ,2 ,4 ,5 ]
机构
[1] St Michaels Hosp, Dept Anesthesia, 30 Bond St, Toronto, ON M5B 1W8, Canada
[2] Univ Toronto, Dept Anesthesiol & Pain Med, Toronto, ON, Canada
[3] Univ Hosp Galway, Dept Anaesthesia, Galway, Ireland
[4] St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada
[5] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada
关键词
cardiopulmonary fitness; exercise testing; functional capacity; postoperative complications; preoperative evaluation; CARDIOPULMONARY EXERCISE TEST; FIELD WALKING TESTS; NONCARDIAC SURGERY; INTRAABDOMINAL SURGERY; CARDIOVASCULAR EVENTS; ANAEROBIC THRESHOLD; ELDERLY-PATIENTS; TROPONIN-T; FITNESS; FRAILTY;
D O I
10.1097/ACO.0000000000000988
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Purpose of review This review examines how functional capacity informs preoperative risk stratification, as well as strengths and limitations of options for estimating functional capacity. Recent findings Functional capacity (or cardiopulmonary fitness) overlaps with other important characteristics, including muscular strength, balance, and frailty. Poor functional capacity is associated with postoperative morbidity, especially noncardiovascular complications. Both patient interviews and exercise tests are used to assess functional capacity. The usual approach of an unstructured patient interview does not predict outcomes. Structured interviews that incorporate validated questionnaires (Duke Activity Status Index) or standardized questions about physical activity (ability to climb stairs) do predict moderate-or-severe complications and cardiovascular complications. Among exercise tests, cardiopulmonary exercise testing (CPET) has shown the most consistent association with risks of complications. Other tests (6-min walk test, incremental shuttle walk test, stair climbing) might predict complications, but still require further high-quality evaluation. A straightforward way to better assess functional capacity is a structured interview with validated questionnaires or standardized questions about physical activities. Functional capacity can also be assessed by exercise tests, with the strongest evidence supporting CPET. Although some simpler exercise tests have shown promise, more research remains needed to better define their role in preoperative evaluation.
引用
收藏
页码:309 / 316
页数:8
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