Authors: Valadkhani, Arman et al.
Anesthesiology, October 3, 2025. DOI: 10.1097/ALN.0000000000005779
This dual-center prospective cohort study investigated the relationship between self-reported functional capacity (measured in metabolic equivalents of task, METs) and surgical outcomes in adults undergoing elective noncardiac surgery. A total of 38,293 patients were included from Karolinska University Hospital between 2020 and 2023. Patients were categorized into MET levels (1, 2–3, 4–5, 6–8, ≥9), and outcomes were assessed for short-term (30-day) and long-term (365-day) mortality, along with days alive and at home (DAH30, DAH365).
At 30 days, mortality was low (0.6%), but by 365 days, mortality reached 5.4% (n=2,061). A dose-response pattern was observed: lower MET levels were strongly associated with higher mortality and shorter survival. Compared to patients with MET ≥9, adjusted relative median survival times decreased progressively—0.75 for MET 6–8, 0.52 for MET 4–5, 0.39 for MET 2–3, and 0.24 for MET 1. Absolute mortality risk differences were also clinically meaningful, ranging from +0.8% for MET 6–8 to +7.2% for MET 1. Lower MET levels additionally correlated with significantly fewer days alive and at home at 365 days.
The findings demonstrate that self-reported MET categories predict both short- and long-term outcomes after surgery. More granular categorization of METs improves risk stratification, supporting its continued use in preoperative assessment and surgical planning.
What You Should Know:
Lower preoperative self-reported MET levels indicate substantially higher postoperative risk, including increased one-year mortality and fewer days alive at home. Incorporating detailed MET categorization into preoperative screening can enhance patient counseling, risk mitigation, and surgical decision-making.
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