The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Department of Surgery, The George Washington University Hospital, Washington, District of Columbia.
J Surg Res. 2024 Nov;303:295-304. doi: 10.1016/j.jss.2024.09.008. Epub 2024 Oct 10.
Open groin vascular surgeries are important in managing peripheral arterial diseases. Given its inherent risks and the diverse patient profiles, there is a need for risk assessment tools. This study aimed to develop a 30-d point-scoring risk calculator for patients undergoing open groin vascular surgeries.
Patients underwent open groin vascular surgery, including aortobifemoral, axillofemoral, femorofemoral, iliofemoral, femoral-popliteal, and femoral-tibial bypass as well as thromboendarterectomy, were identified in American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2021. Patients were randomly sampled into experimental (2/3) and validation (1/3) groups. The George Washington (GW) groin score, a weighted point-scoring system, was developed for 30-d mortality from multivariable regression on preoperative risk variables by Sullivan's method. GW groin score was subjected to internal and external validation. Furthermore, the effectiveness of GW groin score was evaluated in 30-d major surgical complications.
A total of 129,424 patients were analyzed, with 86,715 allocated to experimental group and 42,709 to validation group. GW groin score is derived as follows: aortobifemoral bypass (2 points), axillofemoral bypass (1 point), age (>75 y, 2 points; 65-75 y, 1 point), disseminated cancer (2 points), emergent presentation (1 point), American Society of Anesthesiology score 4 or 5 (1 point), dialysis (1 point), and preoperative sepsis (1 point).GW groin score exhibited robust discrimination (c-statistic = 0.794, 95% CI = 0.786-0.803) and calibration (Brier score = 0.029). The transition from individual preoperative variables (c-statistic = 0.809, 95% CI = 0.801-0.818) to the point-scoring system was successful and external validation of the score was confirmed (c-statistic = 0.789, 95% CI = 0.777-0.801, Brier score = 0.030). Furthermore, GW groin score can effectively discriminate major surgical complications.
This study developed GW groin score, a concise and comprehensive 10-point risk calculator. This well-validated score demonstrates robust discriminative and predictive abilities for 30-d mortality and major surgical complications following open groin vascular surgeries. GW groin score can anticipate potential perioperative complications and guide treatment decisions.
开放腹股沟血管手术在治疗外周动脉疾病方面非常重要。鉴于其固有的风险和多样化的患者特征，需要有风险评估工具。本研究旨在为接受开放腹股沟血管手术的患者开发一个 30 天的点评分风险计算器。
2005 年至 2021 年，在美国外科医师学院国家手术质量改进计划数据库中确定了接受开放腹股沟血管手术的患者，包括主动脉-股总动脉旁路、腋-股总动脉旁路、股-股总动脉旁路、髂股总动脉旁路、股-腘动脉旁路和股-胫动脉旁路以及血栓内膜切除术。患者被随机抽样到实验（2/3）和验证（1/3）组。通过 Sullivan 方法从术前风险变量的多变量回归中，使用乔治华盛顿（GW）腹股沟评分（一种加权点评分系统）来预测 30 天死亡率。GW 腹股沟评分进行了内部和外部验证。此外，GW 腹股沟评分还评估了 30 天内主要手术并发症的有效性。
共分析了 129424 例患者，其中 86715 例患者被分配到实验组，42709 例患者被分配到验证组。GW 腹股沟评分如下：主动脉-股总动脉旁路（2 分）、腋-股总动脉旁路（1 分）、年龄（>75 岁，2 分；65-75 岁，1 分）、弥散性癌症（2 分）、紧急情况（1 分）、美国麻醉医师协会评分 4 或 5（1 分）、透析（1 分）和术前败血症（1 分）。GW 腹股沟评分显示出良好的区分度（c 统计量=0.794，95%CI=0.786-0.803）和校准度（Brier 评分=0.029）。从个体术前变量（c 统计量=0.809，95%CI=0.801-0.818）到点评分系统的转变是成功的，并且确认了评分的外部验证（c 统计量=0.789，95%CI=0.777-0.801，Brier 评分=0.030）。此外，GW 腹股沟评分可以有效地区分主要手术并发症。
本研究开发了 GW 腹股沟评分，这是一种简洁全面的 10 分风险计算器。这个经过良好验证的评分对于开放腹股沟血管手术后 30 天的死亡率和主要手术并发症具有良好的区分和预测能力。GW 腹股沟评分可以预测潜在的围手术期并发症，并指导治疗决策。
