Clinical Tools to Assess Functional Capacity During Risk Assessment Before Elective Noncardiac Surgery : A Scoping...

Area of Science:

• Preoperative Medicine
• Clinical Assessment
• Surgical Risk Stratification

Background:

• Functional capacity is crucial for preoperative risk assessment.
• Current clinical practice lacks standardized guidance for measuring functional capacity.

Purpose of the Study:

• Identify and evaluate functional capacity assessment tools used before surgery.
• Characterize the evidence base for tool performance, including in complex patient populations.

Main Methods:

• Systematic review of MEDLINE, EMBASE, and EBM Reviews up to July 2024.
• Included studies assessed functional capacity tools for risk stratification in elective noncardiac surgery.

Main Results:

• Six performance-based and five patient-reported functional capacity assessment categories were identified.
• Cardiopulmonary exercise testing (CPET) and field walking tests were most studied performance measures.
• Patient-reported measures like Duke Activity Status Index and unstructured assessments were also researched.
• Evidence predominantly focused on predictive validity, with gaps in reliability, pragmatic qualities, and clinical utility for most tools.
• Older adults were well-represented, but data were scarce for patients with obesity, arthritis, or disability.

Conclusions:

• While several tools exist, research heavily favors CPET and predictive validity.
• Significant evidence gaps persist for functional capacity assessment in specific patient subgroups.
• Further research is needed to validate diverse tools and assess clinical utility across varied populations.