CPET is most analysed tool for assessing functionality before surgery

Among the many tools being used to assess functional capacity prior to elective noncardiac surgery, cardiopulmonary exercise testing (CPET) is the most studied, followed by field walking tests, according to a study. Moreover, most research also focuses on only one aspect of validity.

In this systematic review and meta-analysis, investigators searched the databases of Medline, Embase, and EBM Review through July 2024 for studies evaluating the performance of functional capacity assessment tools administered preoperatively to stratify the risk of postoperative outcomes.

Six categories of performance-based tests and five approaches using patient-reported exercise tolerance were identified. Among performance-based tests, CPET was the most common focus of research (132 studies, 32,662 patients), with field walking tests in second place (58 studies, 9,393 patients).

Among patient-reported assessments, the Duke Activity Status Index (14 studies, 3,303 patients) was the most researched, followed by unstructured assessments (19 studies, 28,520 patients).

Notably, most evidence focused on predictive validity (92 percent of studies), particularly accuracy in predicting cardiorespiratory complications.

Evidence on reliability (test consistency across similar measurements), pragmatic qualities (feasibility of implementation), or concurrent criterion validity (correlation to gold standard) were lacking in many tools, and only CPET had evidence on clinical utility (whether administration improved outcomes).

“Older adults (≥65 years) were well represented across studies, whereas there were minimal data in patients with obesity, lower-limb arthritis, and disability,” the investigators said.

The study was limited by its focus on reported data only, with no requests made for missing information.