Newly Published
Editorial Views  |   August 2019
Preoperative Assessment of Functional Capacity: Looking beyond the Ability to Climb Stairs
Author Notes
  • From the Department of Anesthesia and the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada; and the Department of Anesthesia and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
  • Accepted for publication July 26, 2019.
    Accepted for publication July 26, 2019.×
  • Correspondence: Address correspondence to Dr. Wijeysundera: d.wijeysundera@utoronto.ca
Article Information
Editorial Views / Cardiovascular Anesthesia
Editorial Views   |   August 2019
Preoperative Assessment of Functional Capacity: Looking beyond the Ability to Climb Stairs
Anesthesiology Newly Published on August 30, 2019. doi:10.1097/ALN.0000000000002958
Anesthesiology Newly Published on August 30, 2019. doi:10.1097/ALN.0000000000002958
Almost any preoperative evaluation—be it by an anesthesiologist, internal medicine physician, or surgeon—involves asking a patient about the ability to climb one to two flights of stairs or walk several blocks on level ground. Patients’ responses to these questions provide insights into their usual levels of physical activity and their overall cardiopulmonary fitness, which in turn plausibly help with stratifying risk for postoperative morbidity and mortality. In this issue of Anesthesiology, Rubin et al. present an analysis of the National Health and Nutrition Examination Survey that provides important new data on the validity of patients’ self-report as a measure of usual levels of physical activity.1  Participants in this nationally representative sample of the United States population responded to questions about their usual physical activities (e.g., walking or climbing stairs) and also wore accelerometers to objectively measure their physical activity over a 7-day period. Overall, the authors found that typical interview questions related to physical activity were relatively inaccurate tools for screening out significantly inactive individuals who did not complete at least 2 min of moderate-to-vigorous activity (i.e., walking two blocks at 4 mi/h) over a 7-day period. While the self-reported inability to climb 10 stairs had reasonably good performance (positive likelihood ratio of 3.9) for identifying inactive individuals, the self-reported ability to climb 10 stairs and walk two to three blocks had relatively weak ability to rule out inactivity (negative likelihood ratio of 0.5).