Revista do Colégio Brasileiro de Cirurgiões
https://revistadocbc.org.br/article/doi/10.1590/0100-6991e-2026002626
Revista do Colégio Brasileiro de Cirurgiões
Artigo de Revisão

Estratificação do risco cardíaco perioperatório: a avaliação da capacidade funcional é capaz de predizer complicações perioperatórias, incluindo óbito?

Perioperative cardiac risk stratification: is functional capacity assessment able to predict perioperative complications, including death?

Gabriela Chaves Lucas; Soraya Anita Mendes Sá; Thyago Araújo Fernandes; José Carlos Rodrigues Nascimento; Nuno Domingos Garrido; Victor Reis Machado; José Manuel Vilaça Alves

http://dx.doi.org/10.1590/0100-6991e-2026002626 RCBC, vol.53, e2026002626, 2026
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Resumo

Introdução: A triagem de risco perioperatório visa otimizar a tomada de decisão clínica por meio da identificação do risco cardíaco em pacientes submetidos a cirurgias não cardíacas. As diretrizes atuais de organizações como a European Society of Cardiology (ESC) e Sociedade Brasileira de Cardiologia (SBC) incorporam avaliações subjetivas da capacidade funcional, frequentemente utilizando o limiar de 4 METs como marcador de baixa capacidade funcional. Apesar das atualizações recentes dessas diretrizes, a literatura permanece conflitante, e o poder preditivo das ferramentas subjetivas para desfechos perioperatórios é incerto.

Métodos: Conduzimos uma revisão sistemática, em conformidade com as diretrizes PRISMA, sobre a eficácia de ferramentas de avaliação subjetiva da capacidade funcional quanto ao seu poder preditivo para complicações cardíacas perioperatórias, incluindo morte. Foram pesquisadas quatro bases de dados: PUBMED, SCOPUS, WOS e Science Direct.

Resultados: Os resultados indicam que a capacidade autorreferida de subir dois lances de escadas, embora demonstre poder associativo, frequentemente não melhora o poder preditivo dos modelos de risco. Em contraste, ferramentas de avaliação mais abrangentes com dados contínuos, como o Duke Activity Status Index (DASI) e os níveis semanais de atividade física, parecem ser mais promissoras.

Conclusões: Esses resultados sugerem que as diretrizes atuais de estratificação de risco perioperatório necessitam de reavaliação crítica no que se refere à inclusão da capacidade funcional subjetiva. É de suma importância distinguir de forma eficaz o poder associativo da avaliação subjetiva da capacidade funcional de seu poder preditivo, quando comparado às informações já obtidas do paciente.

Palavras-chave

Risco Cardíaco Perioperatório; Avaliação da Capacidade Funcional; Perioperatório; MACE

Abstract

Introduction: Perioperative risk screening seeks to optimize medical decision-making by identifying cardiac risk in patients undergoing noncardiac surgery. The current guidelines of organizations such as the European Society of Cardiology (ESC) and the Brazilian Society of Cardiology (SBC)incorporate assessments of subjective functional capacity, often using the threshold of 4 METs as a marker of low functional capacity. Despite recent updates to these guidelines, the literature remains conflicting, and the predictive power of subjective tools for perioperative outcomes is uncertain.

Methods: We conducted a systematic review, in accordance with PRISMA guidelines, on the effectiveness of subjective functional capacity assessment tools regarding their predictive power for perioperative cardiac complications, including death. Four databases were searched: PUBMED, SCOPUS, WOS, and Science Direct.

Results: The results indicate that the self-reported ability to climb two flights of stairs, although demonstrating associative power, often did not improve the predictive power of risk models. In contrast, more comprehensive assessment tools with continuous data, such as the Duke Activity Status Index (DASI) and weekly levels of physical activity, appear to be more promising.

Conclusion: These results suggest that current perioperative risk stratification guidelines need to be critically re-evaluated with regard to the inclusion of subjective functional capacity. It is of paramount importance to effectively distinguish the associative power of the subjective assessment of functional capacity from its predictive power when compared with information already obtained from the patient.

Keywords

Perioperative Cardiac Risk; Functional Capacity Assessment; Perioperative; MACE

Referências

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02/03/2026

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