Anesthesiology Journal's podcast Featured Author Podcast: Preoperative Functional Capacity and Outcome
Feb 9, 2026
Duminda N. Wijeysundera, a professor in anesthesiology and health policy, critiques subjective preop fitness checks. Arman Valadkhani, an anesthesiologist and researcher, reports a large prospective study using granular METs. They discuss limitations of self-report, benefits of structured MET questionnaires, study design and statistics, and practical steps to improve preoperative functional assessment.
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Limits Of The 4‑MET Cutoff
- Self-reported METs have been used widely but the evidence is heterogeneous and often binary at a 4-MET cutoff.
- Granular assessment of METs may reveal more nuanced associations with postoperative outcomes than a single threshold.
Use Structured METs With Clinician Review
- Use a standardized, five-level categorical METs survey and allow clinicians to amend patient responses when inconsistent with history.
- Combine mortality and days-at-home-alive metrics to capture both death and morbidity after surgery.
Why They Used Advanced Statistical Models
- Accelerated failure time models produce time ratios that describe duration differences instead of hazard ratios.
- Logistic quantile regression models capture distributional changes in bounded outcomes like days-at-home-alive.