Fernandes Antero, Rodrigues Jéssica, Antunes Luís, Lages Patrícia, Santos Carla Salomé, Moreira-Gonçalves Daniel, Costa Rafael S, Sousa Joaquim Abreu, Dinis-Ribeiro Mário, Santos Lúcio Lara
Experimental Pathology and Therapeutics Group, Portuguese Oncology Institute of Porto FG, EPE (IPO-Porto), Porto, Portugal.
Polyvalent Intensive Care Unit, Hospital Garcia de Orta, E.P.E, Almada, Portugal.
Perioper Med (Lond). 2020 Aug 6;9:23. doi: 10.1186/s13741-020-00151-7. eCollection 2020.
Gastrointestinal cancer surgery continues to be a significant cause of postoperative complications and mortality in high-risk patients. It is crucial to identify these patients. Our study aimed to evaluate the accuracy of specific perioperative risk assessment tools to predict postoperative complications, identifying the most informative variables and combining them to test their prediction ability as a new score.
A prospective cohort study of digestive cancer surgical patients admitted to the surgical intermediate care unit of the Portuguese Oncology Institute of Porto, Portugal was conducted during the period January 2016 to April 2018. Demographic and medical information including sex, age, date from hospital admission, diagnosis, emergency or elective admission, and type of surgery, were collected. We analyzed and compared a set of measurements of surgical risk using the risk assessment instruments P-POSSUM Scoring, ACS NSQIP Surgical Risk Calculator, and ARISCAT Risk Score according to the outcomes classified by the Clavien-Dindo score. According to each risk score system, we studied the expected and observed post-operative complications. We performed a multivariable regression model retaining only the significant variables of these tools (age, gender, physiological P-Possum, and ACS NSQIP serious complication rate) and created a new score (). The predictive ability of each continuous score and the final panel obtained was evaluated using ROC curves and estimating the area under the curve (AUC).
We studied 341 patients. Our results showed that the predictive accuracy and agreement of P-POSSUM Scoring, ACS NSQIP Surgical Risk Calculator, and ARISCAT Risk Score were limited. The , shows to have greater discrimination ability than the one obtained with the other risk tools when evaluated individually (AUC = 0.808; 95% CI: 0.755-0.862). The expected and observed complication rates were similar to the new risk tool as opposed to the other risk calculators.
The feasibility and usefulness of the have been demonstrated for the evaluation of patients undergoing digestive oncologic surgery. However, it requires further testing through a multicenter prospective study to validate the predictive accuracy of the proposed risk score.
胃肠道癌手术仍然是高危患者术后并发症和死亡的重要原因。识别这些患者至关重要。我们的研究旨在评估特定围手术期风险评估工具预测术后并发症的准确性，确定最具信息量的变量并将它们组合起来，以测试其作为新评分的预测能力。
对2016年1月至2018年4月期间入住葡萄牙波尔图肿瘤研究所外科中级护理病房的消化道癌手术患者进行了一项前瞻性队列研究。收集了人口统计学和医学信息，包括性别、年龄、入院日期、诊断、急诊或择期入院以及手术类型。我们根据Clavien-Dindo评分分类的结果，使用风险评估工具P-POSSUM评分、美国外科医师学会国家外科质量改进计划（ACS NSQIP）手术风险计算器和ARISCAT风险评分，分析并比较了一组手术风险测量值。根据每个风险评分系统，我们研究了预期和观察到的术后并发症。我们进行了多变量回归模型，仅保留这些工具的显著变量（年龄、性别、生理P-Possum和ACS NSQIP严重并发症发生率），并创建了一个新的评分（）。使用ROC曲线并估计曲线下面积（AUC）评估每个连续评分和最终面板的预测能力。
我们研究了341例患者。我们的结果表明，P-POSSUM评分、ACS NSQIP手术风险计算器和ARISCAT风险评分的预测准确性和一致性有限。单独评估时，[新评分名称]显示出比其他风险工具更高的辨别能力（AUC = 0.808；95% CI：0.755 - 0.862）。与其他风险计算器相比，新风险工具的预期和观察到的并发症发生率相似。
[新评分名称]在评估接受消化道肿瘤手术的患者方面的可行性和实用性已得到证明。然而，它需要通过多中心前瞻性研究进行进一步测试，以验证所提出风险评分的预测准确性。
