Duke Activity Status Index Versus PROMIS Computer Adaptive Testing-Physical Function for Preoperative Assessment

To compare the performance of the patient-reported outcomes measurement information system computer adaptive testing-physical function (PROMIS CAT-PF) to the Duke Activity Status Index (DASI) as a potential alternative physical function domain assessment to assist with preoperative risk assessment.

Patients consisted of a retrospective convenience sample of all adults who had a DASI or PROMIS CAT-PF score obtained from January 1, 2021 to December 31, 2022, within 90 days prior to elective surgery. DASI and PROMIS CAT-PF obtained within one month before a stress test was used to assess the correlation between actual metabolic equivalents attained and the 2 patient-facing questionnaires. To assess the ability to predict adverse outcomes, we used a composite outcome of either death or myocardial injury within 30 days of the surgery.

In comparing DASI and PROMIS CAT-PF correlation to actual metabolic equivalents achieved on stress testing, the DASI Spearman's coefficient of 0.46 (95% CI, 0.32-0.58) was numerically better than the PROMIS CAT-PF Spearman's coefficient of 0.39 (95% CI, 0.21-0.52); however, the difference was not statistically significant. Using a composite outcome of either death or myocardial injury, DASI (area under the curve of 0.712) and PROMIS CAT-PF (area under the curve of 0.773) reported fair predictive utility. The 2 patient-reported physical function domain scores showed weak correlation (κ=0.509).

PROMIS CAT-PF performs as well as DASI, demonstrating a small incremental benefit in predicting adverse postoperative outcomes, and could be an alternative physical function domain assessment used in the preoperative evaluation of patients.