Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study.

BACKGROUND: The Duke Activity Status Index (DASI) questionnaire might help incorporate self-reported functional capacity into preoperative risk assessment. Nonetheless, prognostically important thresholds in DASI scores remain unclear. We conducted a nested cohort analysis of the Measurement of Exercise Tolerance before Surgery (METS) study to characterise the association of preoperative DASI scores with postoperative death or complications. METHODS: The analysis included 1546 participants (≥40 yr of age) at an elevated cardiac risk who had inpatient noncardiac surgery. The primary outcome was 30-day death or myocardial injury. The secondary outcomes were 30-day death or myocardial infarction, in-hospital moderate-to-severe complications, and 1 yr death or new disability. Multivariable logistic regression modelling was used to characterise the adjusted association of preoperative DASI scores with outcomes. RESULTS: The DASI score had non-linear associations with outcomes. Self-reported functional capacity better than a DASI score of 34 was associated with reduced odds of 30-day death or myocardial injury (odds ratio: 0.97 per 1 point increase above 34; 95% confidence interval [CI]: 0.96-0.99) and 1 yr death or new disability (odds ratio: 0.96 per 1 point increase above 34; 95% CI: 0.92-0.99). Self-reported functional capacity worse than a DASI score of 34 was associated with increased odds of 30-day death or myocardial infarction (odds ratio: 1.05 per 1 point decrease below 34; 95% CI: 1.00-1.09), and moderate-to-severe complications (odds ratio: 1.03 per 1 point decrease below 34; 95% CI: 1.01-1.05). CONCLUSIONS: A DASI score of 34 represents a threshold for identifying patients at risk for myocardial injury, myocardial infarction, moderate-to-severe complications, and new disability.

Intentions and barriers to research activities among Australian and New Zealand anaesthetists: a Survey.

A voluntary, anonymous, cross-sectional online survey was conducted among 997 Fellows of the Australian and New Zealand College of Anaesthetists, using an electronic questionnaire. Details about their demographics, employment, research experience and barriers they had encountered, their perception about research and their future intentions to participate in research, were collected. The survey response rate was 24.6%. At the time of the survey, 29% of the survey respondents were involved in research. Respondents currently involved in research were more likely to be practising at a tertiary hospital, to have previously presented at conferences, to believe in the importance of research and to intend to undertake further research training (P <0.05). Time constraints were the most commonly cited reason for not currently performing research. Those who were involved in research spent about 6.3 more hours per week in public practice than those who were not (P=0.012) and had about 4.4 more hours per week of non-clinical time (P <0.001). In terms of barriers encountered during previous projects, 91% of the respondents cited methodological issues, which included complicated ethics approval processes, difficulty in coordinating teams or recruiting participants, non-compliant patients and difficulty in publishing. Sixty-three percent of those surveyed believed more exposure to research activities during training would increase the number of anaesthetists involved in research and scholarly activities. Through this survey, we have identified several areas that, if satisfactorily addressed, could enhance interest and participation in research amongst anaesthetists in Australia and New Zealand.