Key result
FitMáx questionnaire accurately identifies high-risk surgical patients with an AUC of 0.93.
Why the study?
Low cardiorespiratory fitness increases postoperative morbidity and mortality risk, but cardiopulmonary exercise testing is not widely available for preoperative assessment.
Do patient-reported questionnaires accurately predict CPET-VO2peak to identify high-risk surgical patients?
Cross-Sectional (n=361)
Yes
Do patient-reported questionnaires accurately predict CPET-VO2peak to identify high-risk surgical patients?
The FitMáx and VSAQ questionnaires can effectively identify high-risk surgical patients preoperatively, allowing for targeted referral for formal cardiopulmonary exercise testing.
FitMáx and VSAQ may aid preoperative screening; leaves open prospective validation against CPET for surgical outcomes.
Low cardiorespiratory fitness (CRF) increases the risk of postoperative morbidity and mortality following major surgery. Assessing CRF preoperatively, by measuring peak oxygen uptake (VO 2peak ) during cardiopulmonary exercise testing (CPET), is valuable yet not widely available. This study aimed to assess whether questionnaires could be used preoperatively to identify high-risk surgical patients. Healthy participants and patients who underwent CPET completed the FitMáx, Duke Activity Status Index (DASI), the modified 4-questions DASI (M-DASI-4Q), Veterans-Specific Activity Questionnaire (VSAQ), and Metabolic Equivalents of Task (MET) questionnaire. Questionnaire-VO 2peak was compared with CPET-VO 2peak . Overall performance of the questionnaires was assessed by the area under the curve (AUC) of receiver operating characteristic (ROC) curves. Furthermore, corresponding to the Youden index or pre-specified levels, sensitivity, specificity, and predictive values were determined. In total, 361 participants were included. All questionnaires showed high AUC values to identify high-risk patients, defined on the basis of CPET-VO 2peak thresholds. FitMáx and VSAQ demonstrated superior results compared to the other questionnaires. Based on the Youden index, the optimal questionnaire-VO 2peak cut-off values were 20.6, 21.3, and 26.1 ml·kg −1 ·min −1 for the FitMáx and 16.3, 18.2, and 20.4 ml·kg −1 ·min −1 for the VSAQ corresponding to the VO 2peak thresholds 16.0, 18.2 and 24.5 ml·kg −1 ·min −1 respectively. The ability to identify high-risk surgical patients preoperatively (defined by the CPET-VO 2peak thresholds) by the FitMáx and the VSAQ indicates that they could be used to identify high-risk surgical patients. Patients with a poor predicted VO 2peak ≤ 21.3 and ≤ 18.2 ml·kg −1 ·min −1 , respectively for FitMáx and VSAQ, should be referred to formal preoperative (cardiopulmonary) exercise testing. The study was registered as NL-OMON23304 in the Overview of Medical Research in the Netherlands, retrospectively at 28–04-2020.
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Meijer et al. (2024) conducted a cross-sectional in Preoperative surgical risk (n=361). Patient-reported fitness questionnaires (FitMáx, VSAQ, DASI, M-DASI-4Q, MET) vs. Cardiopulmonary exercise testing (CPET) was evaluated on Area under the curve (AUC) for identifying patients with CPET-VO2peak ≤ 16.0 ml·kg−1·min−1 (AUC 0.93, 95% CI 0.90-0.95). The FitMáx questionnaire accurately identified high-risk surgical patients defined by a CPET-VO2peak threshold of ≤16.0 ml/kg/min, achieving an area under the curve of 0.93.
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