Individuals with poor functional capacity are at increased risk of perioperative complications. The Duke Activity Status Index (DASI) can ascertain the maximum physical activity achievable. However, the accuracy of the DASI score in identifying high-risk individuals is unclear. The objective of this systematic review was to determine the association between the DASI score and postoperative complications.

Studies conducted in adults undergoing elective or emergency noncardiac surgery were eligible. The search strategy used MEDLINE, EMBASE, EMCARE and Cochrane CENTRAL, from January 1st, 1988 to August 8th, 2024. Study quality and risk of bias were evaluated independently by two assessors.

Of 5989 citations, nine studies (3100 participants) were included. The DASI score was associated with postoperative mortality (two studies, 732 participants) and postoperative cardiovascular complications (two studies, 2055 participants). The DASI score provided fair prediction of postoperative complications (three studies, area under the receiver operating characteristic curve range 0.71 to 0.75). Marked study heterogeneity precluded meta-analysis.

This systematic review found an association between low DASI scores and cardiovascular complications, postoperative complications and mortality, and variable association between DASI scores and hospital length of stay. The major limitation to the evidence was the significant heterogeneity of study population, outcome definitions, DASI thresholds and cardiovascular endpoints.

Amongst adults undergoing noncardiac surgery, the DASI score is associated with postoperative complications, cardiovascular complications and mortality. Further research is required to identify a DASI threshold (or confirm the DASI threshold of 34) that accurately predicts postoperative complications, including major cardiac events.

This systematic review was registered with PROSPERO on March 4th, 2024 (CRD42024331864). No funding was obtained for this review.