Findings of a multicenter prospective cohort study published in Anaesthesia indicate a functional decline in about 25% of participants post a major elective non-cardiac surgery. 

Self-reported functional recovery after an intervention is a vital patient-centered outcome. However, research and decision-making often fail to measure it. 


The measurement of exercise tolerance before surgery (METS) study was subjected to secondary analysis by K. S. Ladha, St. Michael's Hospital, Canada, and colleagues. An analysis was done to establish the relation between functional decline after a major non-cardiac intervention and the peri-operative variables.

The researchers included patients scheduled for a non-cardiac surgery who were 40 years of age and above in the study. All these patients either showed coronary artery disease or were at risk of coronary artery disease.

The primary outcomes were defined as:

  • A decline in the ability to conduct regular activities (EuroQol 5 dimension)

  • Diminished self-care

  • Reduction in mobility

The outcomes were monitored and compared from 30 days prior to the surgery to about 1 year post-surgery.


  • At 30 days out of the 1309 participants included in the study, 539 (40%) were noted to decline at least one function.

  • A decline in function was reported more often 30 days after the intervention by participants who demonstrated higher pre-operative Duke Activity Status indices.

  • 1 year post-surgery functional decline was less often reported by the participants who demonstrated higher pre-operative Duke Activity Status indices.

  • The functional decline exhibited an odds ratio (OR) with moderate or severe postoperative complications at 30 days as 95% CI 1.46 (1.02–2.09), p = 0.037 

  • The functional decline exhibited an OR with moderate or severe post-operative complications 1 year post the surgery as 1.44 (0.98–2.13), p = 0.066.

  • Poor discrimination of participants with functional decline at 30 days (c-statistic) 0.61 and 1 year (c-statistic 0.63) post the intervention was noted. 

  • Up to one post-operative year, a functional decline was inferred in 1/4th of the participants.

Improvement in at least one EQ-5D functional domain was reported by fewer participants, while more reported a decline 30 days after the surgery.


Disease Condition,Therapeutic Modality,Coronary Artery Disease,Interventional Cardiology,DCAD_others,TINC_others