Only 16 (9%) patients had lower METs quantified by exercise cardiac stress test than estimated by history. The exercise cardiac stress test measured METs was on average 3.3 METs higher than the METs estimated from the preoperative evaluation clinic history. During preoperative assessments at the BWH preoperative evaluation clinic, the METs of a patient are estimated by history using the BWH preoperative evaluation clinic METs Table ( Table 1), which gives examples of physical activities and their MET equivalents based on known standards.īland–Altman plot of METs estimated from history versus measured by exercise cardiac stress testing. Exercise cardiac stress tests at BWH use the Bruce Protocol for quantification of METs. For those patients that had exercise cardiac stress tests ( N=170), we noted the METs of the patient estimated by history and the METs quantified by the exercise cardiac stress test following the visit. The types of cardiac stress tests, exercise or nonexercise, were assessed. Medical charts with patients undergoing cardiac stress tests without an available preoperative anesthesia evaluation note ( N=96) or an incomplete anesthesia evaluation note ( N=28) were excluded.
#METS SCORE CALCULATOR PASSWORD#
Clinical data were extracted from the medical charts in a de-identified manner and stored in an encrypted and password protected excel spreadsheet that was created specifically for this study. Using this software, we identified patients that underwent cardiac stress tests ordered by an anesthesiologist at the BWH preoperative evaluation clinic from to.
#METS SCORE CALCULATOR SOFTWARE#
BWH uses the computer software program Precipio to order cardiac stress tests. The Brigham and Women's Hospital (BWH) Institutional Review Board (IRB) granted approval for the chart review and waived individual consent. Therefore, we performed a single-center retrospective study over a ten-year period to examine the accuracy of anesthesiologists' assessments of patient's METs in the anesthesia preoperative evaluation by comparing the preoperative metabolic equivalents (METs) estimated from history to the formally quantified METs during exercise cardiac stress testing. The focus of this study was the accuracy of the patient's METs obtained by history in the anesthesia preoperative evaluation. Previous studies have focused on quantifying physical activities with quantified METs and correlating the METs to outcomes. If a patient cannot perform four METs, this could prompt further cardiac workup by the Stepwise Approach to Perioperative Cardiac Assessment Treatment algorithm from the ACC/AHA Guidelines on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery, because these patients have increased postoperative complications. An accurate preoperative assessment of a patient's METs is important.
It is well known that patients with low METs are at increased risk for perioperative morbidity and mortality. This assessment provides an estimate of a patient's METs that is assumed to correspond to a formal quantitative measurement of METs performed during a cardiac exercise stress test. Traditionally, a patient's maximum METs are quantified by querying them for a description of their physical activities and using activity scales, which correlates a physical activity with a quantified number of METs. These measurements have been utilized in preoperative assessments of patients where a patient's functional capacity is described in METs and for risk stratification for perioperative complications for patients undergoing noncardiac surgical procedures. The maximum amount of metabolic work that an individual can perform can be described in MET units and this corresponds to overall cardiovascular fitness. One metabolic equivalent (MET) is defined as the basal oxygen consumption of a 40-year-old 70 kg man.
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