São João Hospital Centre, Alameda Prof Hernani Monteiro, 4200-319, Porto, Portugal; Faculdade de Medicina da Universidade Do Porto, Alameda Prof Hernani Monteiro, 4200-319, Porto, Portugal.
São João Hospital Centre, Alameda Prof Hernani Monteiro, 4200-319, Porto, Portugal.
Int J Surg. 2020 Jan;73:89-93. doi: 10.1016/j.ijsu.2019.12.010. Epub 2019 Dec 14.
Noncardiac vascular surgery (VS) patients have comorbidities that increase the risk of death after surgery. Assessing that risk is important to allocate the necessary resources and improve quality of care. We aimed to evaluate the incidence and predictors of 30-day post-operative mortality (POM) after VS and compare the performance of existing risk scores.
Prospective cohort study including consecutive patients submitted to elective VS at a tertiary university hospital. We collected patients' demographics/perioperative data and calculated Surgical Apgar, age-adjusted Charlson Comorbidity Index (CCI), Vascular-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (V-POSSUM) and Preoperative Score to Predict Postoperative Mortality (POSPOM). We performed multivariate logistic regression to assess independent factors with Odds Ratio (OR) and 95% confidence interval (CI) calculation and Cox-regression for time-to-event analysis. We tested the predictive ability of the scores using the area under ROC curve (AUROC).
POM was 6.2% (n = 19/306), not different from expected by V-POSSUM (6.5%) or POSPOM (5.6%). Post-operative myocardial infarction (MI) and acute kidney injury (AKI) were associated with higher POM (OR 4.8, p = 0.011 and OR 5.4, p = 0.001, respectively). On multivariate analysis, Chronic kidney disease (CKD) (OR 4.0, p = 0.021), Age (OR 1.1, p = 0.002), Peripheral arterial disease (PAD) (OR 8.0, p = 0.006), intra-operative red blood cells (RBC) Transfusion (OR 1.9, p < 0.001) and Atrial fibrillation (OR 8.4, p = 0.002) were considered independent predictors of POM (CAPTA score). The AUROC of our model was 0.882, better V-POSSUM (0.858), POSPOM (0.784), CCI (0.732) or Surgical Apgar (0.649).
Observed POM was similar to predicted by V-POSSUM or POSPOM. Age, PAD, CKD, atrial fibrillation and intraoperative RBC transfusion were independent risk factors for POM. Score V-POSSUM performed better than POSPOM, CCI or Surgical Apgar.
非心脏血管手术（VS）患者存在增加术后死亡风险的合并症。评估这种风险对于分配必要的资源和提高护理质量非常重要。我们旨在评估 VS 后 30 天术后死亡率（POM）的发生率和预测因素，并比较现有风险评分的表现。
这是一项前瞻性队列研究，纳入了在一所三级大学医院接受择期 VS 的连续患者。我们收集了患者的人口统计学/围手术期数据，并计算了手术 Apgar、年龄调整 Charlson 合并症指数（CCI）、血管生理和手术严重程度评分用于死亡率和发病率的计数（V-POSSUM）以及预测术后死亡率的术前评分（POSPOM）。我们进行了多变量逻辑回归分析，以评估具有优势比（OR）和 95%置信区间（CI）计算的独立因素，并进行 Cox 回归进行时间事件分析。我们使用 ROC 曲线下面积（AUROC）来测试评分的预测能力。
POM 为 6.2%（n=19/306），与 V-POSSUM（6.5%）或 POSPOM（5.6%）预测的死亡率无差异。术后心肌梗死（MI）和急性肾损伤（AKI）与较高的 POM 相关（OR 4.8，p=0.011 和 OR 5.4，p=0.001）。在多变量分析中，慢性肾脏病（CKD）（OR 4.0，p=0.021）、年龄（OR 1.1，p=0.002）、外周动脉疾病（PAD）（OR 8.0，p=0.006）、术中红细胞（RBC）输血（OR 1.9，p<0.001）和心房颤动（OR 8.4，p=0.002）被认为是 POM 的独立预测因素（CAPTA 评分）。我们模型的 AUROC 为 0.882，优于 V-POSSUM（0.858）、POSPOM（0.784）、CCI（0.732）或手术 Apgar（0.649）。
观察到的 POM 与 V-POSSUM 或 POSPOM 预测的 POM 相似。年龄、PAD、CKD、心房颤动和术中 RBC 输血是 POM 的独立危险因素。V-POSSUM 评分的表现优于 POSPOM、CCI 或手术 Apgar。
