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

Area of Science:

• Cardiology
• Preoperative Assessment
• Exercise Physiology

Background:

• Low cardiorespiratory fitness (CRF) is linked to increased postoperative complications and mortality.
• Preoperative assessment of CRF via cardiopulmonary exercise testing (CPET) is valuable but not widely accessible.
• Identifying high-risk surgical patients preoperatively is crucial for optimizing outcomes.

Purpose of the Study:

• To evaluate the effectiveness of questionnaires in identifying high-risk surgical patients based on CRF.
• To compare the performance of FitMáx, DASI, M-DASI-4Q, VSAQ, and MET questionnaires in predicting VO2peak.
• To determine optimal cut-off values for questionnaires to identify patients needing further preoperative evaluation.

Main Methods:

• Participants completed multiple CRF questionnaires and underwent CPET for VO2peak measurement.
• Questionnaire-predicted VO2peak was compared against CPET-measured VO2peak.
• Receiver operating characteristic (ROC) curve analysis, including AUC, sensitivity, specificity, and Youden index, was used to assess questionnaire performance.

Main Results:

• All questionnaires demonstrated high AUC values in identifying high-risk patients.
• FitMáx and VSAQ showed superior performance compared to other questionnaires.
• Optimal cut-off values were identified for FitMáx (e.g., ≤21.3 ml·kg-1·min-1) and VSAQ (e.g., ≤18.2 ml·kg-1·min-1) to flag patients for further testing.

Conclusions:

• The FitMáx and VSAQ questionnaires are effective tools for identifying high-risk surgical patients preoperatively.
• Patients with predicted low VO2peak using these questionnaires should be referred for formal preoperative CPET.
• These validated questionnaires offer a practical alternative for assessing CRF in surgical patients.