Functional decline after severe COVID-19: duke activity status index for preoperative risk assessment

Survivors of severe COVID-19 (Coronavirus Disease 2019) frequently experience long-term functional impairment, a condition known as post-COVID syndrome. As these patients may eventually undergo surgical procedures, evaluating their functional capacity becomes essential for safe anesthetic management. The Duke Activity Status Index (DASI) is a validated, easy-to-administer tool that correlates with cardiopulmonary fitness and surgical risk.

To evaluate changes in functional capacity using DASI scores in patients who survived severe COVID-19, comparing pre- and post-infection performance, and to assess implications for perioperative care.

A retrospective observational study was conducted including 31 patients with a history of severe COVID-19 requiring ICU (Intensive Care Unit) admission. DASI scores were collected before and after hospitalization due to COVID-19. Associations between DASI variation and clinical variables (e.g., presence of pleural effusion, duration of intubation, ICU stay) were also explored.

A marked decline in functional capacity was observed after COVID-19, with lower DASI scores post-infection. The presence of pleural effusion and ultrasound abnormalities were associated with more pronounced reductions in DASI scores. A strong correlation was found between duration of intubation and length of hospital stay, and between post-COVID DASI and percentage variation.

Severe COVID-19 has a lasting impact on functional capacity as measured by DASI. These findings highlight the need for anesthesiologists to include functional assessments in the preoperative evaluation of patients with a history of severe COVID-19. Integrating DASI into routine pre-anesthetic workup may improve risk stratification and perioperative outcomes in this vulnerable population.