Department of Anaesthesiology, Int-ensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Neurosurgery. 2018 Aug 1;83(2):197-202. doi: 10.1093/neuros/nyx385.
Patient-reported preoperative factors hold promise in improving the prediction of postoperative adverse events, but they have been poorly studied.
To study the role of patient-reported factors in the preoperative risk stratification of elective craniotomy patients.
A prospective, unselected cohort of 322 adult patients underwent elective craniotomy in Helsinki, Finland. We preoperatively recorded the American Society of Anesthesiologists (ASA) score, Helsinki ASA score, and 3 questionnaire-based patient-reported factors including overall health status, ability to climb 2 flights of stairs, and cognitive function (Test Your Memory test). Outcome measures comprised in-hospital major and overall morbidity. Receiver-operating characteristic curves served to calculate area under the curve (AUC) values for a composite score of patient-reported factors and both ASA scores with regard to outcomes.
In-hospital major and overall morbidity rate was 15.2%. Only preoperatively diminished cognitive function remained a significant predictor of major morbidity after multivariable logistic regression analysis (P < .001, odds ratio 1.1, confidence interval 1.0-1.1). A composite score of our 3 patient-reported factors had a higher AUC (0.675) for major morbidity than original ASA score (0.543) or Helsinki ASA score (0.572). In elderly patients, the composite score had an AUC of 0.726 for major morbidity.
Preoperative patient-reported factors had higher sensitivity for detecting major morbidity compared to the ASA scores in this study. Particularly, the simple composite score seems to predict adverse outcomes in elective cranial surgery surprisingly well, especially in the elderly. These results are interesting and worth confirming in other centers.
患者报告的术前因素在改善术后不良事件预测方面具有潜力，但研究甚少。
研究患者报告因素在择期开颅手术患者术前风险分层中的作用。
前瞻性、未选择的 322 例成年患者在芬兰赫尔辛基接受择期开颅手术。我们术前记录美国麻醉医师协会（ASA）评分、赫尔辛基 ASA 评分和 3 项基于问卷的患者报告因素，包括整体健康状况、爬 2 段楼梯的能力和认知功能（Test Your Memory 测试）。结局包括院内主要和总体发病率。受试者工作特征曲线用于计算患者报告因素和 ASA 评分的复合评分对结局的曲线下面积（AUC）值。
院内主要和总体发病率为 15.2%。只有术前认知功能下降仍然是多变量逻辑回归分析后主要发病率的显著预测因素（P<0.001，优势比 1.1，95%置信区间 1.0-1.1）。我们 3 项患者报告因素的复合评分对主要发病率的 AUC（0.675）高于原始 ASA 评分（0.543）或赫尔辛基 ASA 评分（0.572）。在老年患者中，复合评分对主要发病率的 AUC 为 0.726。
与本研究中的 ASA 评分相比，术前患者报告的因素对检测主要发病率具有更高的敏感性。特别是，简单的复合评分似乎可以很好地预测择期颅脑手术的不良结局，尤其是在老年人中。这些结果很有趣，值得在其他中心进一步证实。
