Kokkinakis Stamatios, Andreou Alexandros, Venianaki Maria, Chatzinikolaou Charito, Chrysos Emmanuel, Lasithiotakis Konstantinos
Department of Surgery, University Hospital of Heraklion, Medical School, University of Crete, 71110 Heraklion, Greece.
J Clin Med. 2022 Nov 29;11(23):7083. doi: 10.3390/jcm11237083.
Preoperative risk stratification in the elderly surgical patient is an essential part of contemporary perioperative care and can be done with the use of the American College of Surgeons Surgical Risk Calculator (ACS-SRC). However, data on the generalizability of the ACS-SRC in the elderly is scarce. In this study, we report an external validation of the ACS-RC in a geriatric cohort. A retrospective analysis of a prospectively maintained database was performed including patients aged > 65 who underwent general surgery procedures during 2012−2017 in a Greek academic centre. The predictive ability of the ACS-SRC for post-operative outcomes was tested with the use of Brier scores, discrimination, and calibration metrics. 471 patients were included in the analysis. 30-day postoperative mortality was 3.2%. Overall, Brier scores were lower than cut-off values for almost all outcomes. Discrimination was good for serious complications (c-statistic: 0.816; 95% CI: 0.762−0.869) and death (c-statistic: 0.824; 95% CI: 0.719−0.929). The Hosmer-Lemeshow test showed good calibration for all outcomes examined. Predicted and observed length of stay (LOS) presented significant differences for emergency and for elective cases. The ACS-SRC demonstrated good predictive performance in our sample and can aid preoperative estimation of multiple outcomes except for the prediction of post-operative LOS.
老年外科患者的术前风险分层是当代围手术期护理的重要组成部分，可通过使用美国外科医师学会手术风险计算器（ACS-SRC）来完成。然而，关于ACS-SRC在老年人中的通用性的数据很少。在本研究中，我们报告了在老年队列中对ACS-RC的外部验证。对一个前瞻性维护的数据库进行了回顾性分析，纳入了2012年至2017年期间在希腊学术中心接受普通外科手术的65岁以上患者。使用Brier评分、鉴别度和校准指标测试了ACS-SRC对术后结果的预测能力。471名患者纳入分析。术后30天死亡率为3.2%。总体而言，几乎所有结果的Brier评分均低于临界值。严重并发症（c统计量：0.816；95%CI：0.762-0.869）和死亡（c统计量：0.824；95%CI：0.719-0.929）的鉴别度良好。Hosmer-Lemeshow检验显示所有检查结果的校准良好。预测和观察到的住院时间（LOS）在急诊和择期病例中存在显著差异。ACS-SRC在我们的样本中表现出良好的预测性能，除了预测术后LOS外，还可帮助术前估计多种结果。
