How do you determine the Duke Activity Status Index (DASI) score preoperatively in an adult patient with potential comorbidities who is scheduled for surgery?

How to Determine DASI Preoperatively

The Duke Activity Status Index (DASI) is determined by administering a structured 12-item questionnaire to the patient, asking them to report which daily activities they can currently perform, then summing the weighted point values of all activities they endorse to generate a total score ranging from 0 to 58.2. 1

Administration Method

• Ask the patient directly whether they can perform each of the 12 specific activities listed in the DASI questionnaire 1
• The questionnaire should be completed preoperatively, ideally during the preoperative assessment clinic visit 2, 3
• This is a self-reported instrument that can be administered as a written questionnaire or verbally during clinical interview 1, 4
• The assessment takes only a few minutes to complete and requires no special equipment or testing 5

The 12 DASI Activities and Their Point Values

Each activity has a specific metabolic equivalent (MET) weight assigned. Ask: "Can you...":

1. Take care of yourself (eating, dressing, bathing, using toilet)? = 2.75 points 1
2. Walk indoors around your house? = 1.75 points 1
3. Walk a block or two on level ground? = 2.75 points 1
4. Climb a flight of stairs or walk up a hill? = 5.5 points 1
5. Run a short distance? = 8 points 1
6. Do light housework (dusting, washing dishes)? = 2.7 points 1
7. Do moderate housework (vacuuming, sweeping, carrying groceries)? = 3.5 points 1
8. Do heavy housework (scrubbing floors, moving heavy furniture)? = 8 points 1
9. Do yardwork (raking leaves, weeding, pushing power mower)? = 4.5 points 1
10. Have sexual relations? = 5.25 points 1
11. Participate in moderate recreational activities (golf, bowling, dancing, doubles tennis)? = 6 points 1
12. Participate in strenuous sports (swimming, singles tennis, basketball, skiing)? = 7.5 points 1

Score Calculation

• Add together the point values for all activities the patient reports they can perform 1
• The total possible score ranges from 0 to 58.2, with higher scores indicating better functional capacity 1
• A score of ≤34 represents a clinically significant threshold for identifying patients at increased risk of postoperative complications 2, 6

Clinical Interpretation for Perioperative Risk

• DASI scores ≤34 identify patients with poor functional capacity (<4 METs) who have significantly increased risk of 30-day death, myocardial injury, myocardial infarction, and moderate-to-severe complications 2
• DASI scores >34 indicate adequate functional capacity and are associated with reduced odds of perioperative adverse cardiovascular events 2
• The 2024 AHA/ACC guidelines recommend using structured DASI assessment in patients undergoing elevated-risk noncardiac surgery to stratify perioperative cardiovascular risk 1

Integration into Preoperative Risk Assessment

• Combine DASI with other risk indices such as the Revised Cardiac Risk Index (RCRI) for comprehensive risk stratification 5, 7
• DASI provides superior predictive value compared to subjective clinical assessment alone for identifying patients at risk of death or myocardial infarction within 30 days of surgery 4
• For patients with DASI ≤34, consider additional cardiovascular testing or optimization before proceeding with surgery, particularly for intermediate- or high-risk procedures 1

Important Clinical Caveats

• DASI is self-reported and may be influenced by patient perception, cognitive status, or willingness to report limitations 3
• The questionnaire has test-retest reliability of 0.88, indicating good reproducibility 6
• DASI shows fair-to-good discrimination for postoperative complications (area under ROC curve 0.71-0.81) 8, 6
• Patients with good functional capacity (DASI >34) who are asymptomatic can typically proceed to surgery without further cardiovascular testing 4
• The DASI threshold of 34 corresponds roughly to the ability to achieve 4 METs, which is the traditional cutoff used in perioperative risk assessment 4, 2