Related Experiment Video
Updated: Jun 10, 2025
Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
A Retrospective Cohort Study Examining the Validation of the Modified Duke Activity Status Index in the Non-cardiac
Michael Hua-Gen Li1, Morgan Rosser1, Jeanna Blitz1
1Department of Anesthesiology, Duke University Hospital, Durham, NC.
Insights
The Duke Activity Status Index (DASI) reliably predicts long-term outcomes after major non-cardiac surgery. Simplified DASI versions also show predictive power for mortality and myocardial injury in at-risk patients.
Area of Science:
- Cardiology
- Anesthesiology
- Public Health
Background:
- Assessing preoperative risk is crucial for major non-cardiac surgery.
- The Duke Activity Status Index (DASI) measures functional capacity.
- Predictive tools for postoperative outcomes in at-risk patients are needed.
Purpose of the Study:
- To evaluate the Duke Activity Status Index (DASI) and its simplified versions for predicting 30-day mortality and myocardial injury.
- To validate DASI's predictive capability in patients with coronary artery disease risk factors undergoing major non-cardiac surgery.
- To investigate the impact of the Area Deprivation Index (ADI) on DASI scores and outcomes.
Main Methods:
- Retrospective cohort study including 4,199 patients.
- Validated DASI and its variants for predicting composite outcomes (30-day mortality/myocardial injury).
- Assessed 30-day severe complications, 1-year survival, and the influence of Area Deprivation Index (ADI).
Main Results:
- Original and 4-question DASI accurately predicted 30-day composite outcomes (AUC 0.82).
- Both DASI versions predicted 1-year composite outcomes, but not severe complications.
- Higher Area Deprivation Index (ADI) correlated with lower DASI scores, indicating socioeconomic disparities.
Conclusions:
- The Duke Activity Status Index (DASI) is a dependable predictor of long-term postoperative outcomes.
- Simplified DASI versions maintain significant predictive value.
- Socioeconomic factors, measured by ADI, influence functional capacity assessments like DASI.
Purpose:
We aimed to ascertain if the Duke Activity Status Index (DASI) and its simplified variants predict 30-day mortality and myocardial injury after major non-cardiac surgery in at-risk patients.
Design:
Retrospective cohort study.
Methods:
We included 4,199 patients to validate the DASI and its variants in predicting the same composite outcome in patients with risk factors for coronary artery disease. Additional outcomes included 30-day severe complications, 1-year survival, and the effect of the Area Deprivation Index (ADI) on the DASI score and subsequent outcomes.
Findings:
Patients were a median of 66 years old (interquartile range 57.0, 73.0), 47.9% were male, predominantly Caucasian (71.9%), with an American Society of Anesthesiologists score of 3 or greater (80.7%) and a median National ADI of 54.0 (interquartile range 33.0 to 74.0). The 30-day composite outcome was predicted by the original DASI (area under the curve [AUC] 0.82 [CI 0.73, 0.91], P < .001); modified 4-question DASI (AUC 0.82 [CI 0.73, 0.91], P < .048). The original DASI also predicted the 1-year composite outcome (hazard ratio 0.88 [CI 0.84, 0.93], P < .001), as did the modified 4-question DASI (hazard ratio 0.78 [CI 0.69, 0.89], P < .001), but not severe complications (P = .400 and P = .332 respectively). The ADI showed an inverse relationship with all versions of the DASI; there was a 0.8-point DASI decrease ([95% confidence interval -0.96 to -0.59], P < .001) for every 10-point increase in the National ADI.
Conclusions:
The DASI is a reliable predictor of long-term postoperative outcomes.
