Prognostic value of the Duke Activity Status Index (DASI) in patients undergoing colorectal surgery

Abstract

Background Complications are common after colorectal surgery and remain a target for quality improvement. Lower preoperative physical functioning is associated with poor postoperative outcomes, but assessment often relies on subjective judgment or resource‐intensive tests. Recent literature suggests that self‐reported functional capacity, measured using the Duke Activity Status Index (DASI), is a strong predictor of postoperative outcomes. This study aimed to estimate the extent to which DASI predicts 30‐day complications after colorectal surgery. Methods In this observational study, 100 patients undergoing colorectal resection [median age 63, 57% men, 81% laparoscopic, 37% rectal surgery] responded to DASI two weeks preoperatively. Complications were classified according to Clavien–Dindo and quantified using the comprehensive complication index (CCI). Our primary analysis targeted the relationship between preoperative DASI and odds of complications. Secondary analyses focused on 30‐day severe complications, CCI, readmissions, and length of stay (LOS). We also explored the predictive ability of DASI with scores dichotomized based on a previously validated threshold (≤ 34). Results Mean preoperative DASI was 48 ± 12. Forty‐six patients (46%) experienced 30‐day complications (8% severe, CCI 9.6 ± 15). Lower DASI scores were associated with higher odds of complications (OR 1.08, 95%CI 1.03–1.14; p = 0.001). Preoperative DASI was also an independent predictor of severe complications, CCI, and readmissions. The predictive ability was supported when scores were dichotomized at ≤ 34. Conclusion DASI is a significant predictor of postoperative complications after colorectal surgery. This questionnaire can be easily implemented in clinical practice to identify patients with low preoperative functional capacity and target interventions to those at higher risk.

Predicting Length of Stay using machine learning for total joint replacements performed at a rural community hospital

“…Conversely, unlike many PLOS ONE studies, the variable DASI was used in this study and was found as an important predictor of LOS. The researchers have used DASI as a preoperative assessment metric to evaluate postoperative risks, especially in colorectal surgeries [85,86]. To the authors' knowledge, the DASI has not been used in the past TJR studies to predict or measure its association with LOS.…”

Translation, cross-cultural adaptation, and validation of the Duke Activity Status Index (DASI) to Sinhala language

“…However, CPET is resource-intensive, costly, and time-consuming and is not accessible to all pre-operative patients; especially in resource-poor settings (Lai and Hosie 2012 , Neves et al 2013 ). The Duke Activity Status Index (DASI) is a fast, simple, and cost-effective tool initially developed to measure the functional capacity of patients with cardiovascular diseases (Hlatky et al 1989 ) and is now widely used in pre-operative patients to predict functional capacity (El-Kefraoui et al 2021 , Riedel et al 2021 ) and post-operative complications (Wijeysundera et al 2016 ). The DASI consists of 12 items addressing self-care, ambulation, household chores, sexual activity, and recreational activities.…”

Translation, cross-cultural adaptation, and validation of the Duke Activity Status Index (DASI) to Sinhala language: Translation, cross-cultural adaptation, and validation study

“…Cardiopulmonary exercise testing (CPET) is the gold standard objective assessment of functional capacity and cardiorespiratory tness (8, 9). However, CPET is resource-intensive, costly, and timeconsuming and is not accessible to all preoperative patients; especially in resource poor settings (4,10) .The Duke Activity Status Index (DASI) is a fast, simple, and cost-effective tool initially developed to measure functional capacity of patients with cardiovascular diseases (11) and is now widely used in preoperative patients to predict functional capacity (12,13) and post operative complications (7). The DASI consists of 12 items addressing self-care, ambulation, household chores, sexual activity, and recreational activities.…”