Department of Otorhinolaryngology-Head and Neck Surgery, Hospital De Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal.
Polyvalent Intensive Care Unit, Hospital Garcia de Orta, E.P.E, Almada, Portugal.
Eur Arch Otorhinolaryngol. 2021 Jan;278(1):191-202. doi: 10.1007/s00405-020-06133-1. Epub 2020 Jun 18.
To validate tools to identify patients at risk for perioperative complications to implement prehabilitation programmes in head and neck surgery (H&N).
Retrospective cohort including 128 patients submitted to H&N, with postoperative Intermediate Care Unit admittance. The accuracy of the risk calculators ASA, P-POSSUM, ACS-NSQIP and ARISCAT to predict postoperative complications and mortality was assessed. A multivariable analysis was subsequently performed to create a new risk prediction model for serious postoperative complications in our institution.
Our 30-day morbidity and mortality were 45.3% and 0.8%, respectively. The ACS-NSQIP failed to predict complications and had an acceptable discrimination ability for predicting death. The discrimination ability of ARISCAT for predicting respiratory complications was acceptable. ASA and P-POSSUM were poor predictors for mortality and morbidity. Our new prediction model included ACS-NSQIP and ARISCAT (area under the curve 0.750, 95% confidence intervals: 0.63-0.87).
Despite the insufficient value of these risk calculators when analysed individually, we designed a risk tool combining them which better predicts the risk of serious complications.
验证用于识别头颈部手术（H&N）围手术期并发症风险患者的工具，以实施康复前计划。
回顾性队列研究纳入了 128 例接受 H&N 手术并需要入住术后中级护理病房的患者。评估了 ASA、P-POSSUM、ACS-NSQIP 和 ARISCAT 风险计算器预测术后并发症和死亡率的准确性。随后进行了多变量分析，以创建我们机构严重术后并发症的新风险预测模型。
我们的 30 天发病率和死亡率分别为 45.3%和 0.8%。ACS-NSQIP 未能预测并发症，对死亡的预测能力尚可。ARISCAT 对预测呼吸系统并发症的判别能力尚可。ASA 和 P-POSSUM 对死亡率和发病率的预测能力较差。我们的新预测模型包括 ACS-NSQIP 和 ARISCAT（曲线下面积为 0.750，95%置信区间：0.63-0.87）。
尽管这些风险计算器单独分析时价值不足，但我们设计了一种结合使用它们的风险工具，可更好地预测严重并发症的风险。
