Abstract
Introduction. Despite the advances in modern anesthesiology, it is impossible to guarantee a safe course of anesthesia, and even with planned surgical interventions, there is a risk of death. At present, there is no unanimity in approaches to assessing perioperative risk, and many systems for determining this risk have not been validated in Russia. The question of the contribution of pre-operative factors to the likelihood of an unfavorable outcome also remains open, which requires large multicenter national studies.
Objectives. To assessment the predictive value of preoperative factors in determining the risk of death and complications based on the analysis of data obtained during the first year of the STOPRISK study.
Materials and methods. An analysis of data on perioperative indices of 3002 patients operated on the abdominal and pelvic organs from 30 centers in 21 cities of Russia participating in the STOPRISK study is presented.
Results. The mortality rate in the study was 0.47 %, the rate of postoperative complications was 3.9 %. Most often, an unfavorable outcome developed after upper abdominal and colorectal surgery. Despite the fact that the severity of surgery and the ASA class are independent predictors of an unfavorable outcome, the use of these parameters allows to predict postoperative mortality (AUROC = 0.85) and (with age) postoperative complications (AUROC = 0.77) with limited accuracy.
Conclusions. Thus, the probability of an unfavorable outcome can be estimated using factors such as the severity of surgery and the initial physical status, but their predictive value for determining the risk of mortality is clearly insufficient, and even less is their ability to assess the risk of postoperative complications. As shown by literature data, inclusion in model additional risk factors allows to increase the accuracy of the forecast, however, given the peculiarities of the structure of comorbidities and their impact on outcome in the studied population, we need further evaluation of their contribution to perioperative risk. Also, taking into account the peculiarities of the occurrence of some concomitant diseases, further research is required to identify a significant impact on mortality and postoperative complications.
References
- Weiser T.G., Haynes A.B., Molina G., Lipsitz S.R. Size and distribution of the global volume of surgery in 2012. Bull World Health Organ. 2016; 94(3): 201–209F. DOI: 10.2471/BLT.15.159293
- Nepogodiev D., Martin J., Biccard B., et al. National Institute for Health Research Global Health Research Unit on Global Surgery. Global burden of postoperative death. Lancet. 2019; 393(10170): 401. DOI: 10.1016/S0140-6736(18)33139-8
- Scally C.P., Thumma J.R., Birkmeyer J.D., Dimick J.B. Impact of surgical quality improvement on payments in Medicare patients. Ann Surg. 2014; 262: 249–52. DOI: 10.1097/SLA.0000000000001069
- Head J., Ferrie J.E., Alexanderson K., et al. Diagnosis-specific sickness absence as a predictor of mortality: the Whitehall II prospective cohort study. BMJ. 2008; 337: a1469. DOI: 10.1136/bmj.a1469
- International Surgical Outcomes Study (ISOS) group Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. Br J Anaesth. 2017; 119(3): 553. DOI: 10.1093/bja/aew316
- Monk T.G., Saini V., Weldon B.C., Sigl J.C. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg. 2005; 100: 4–10. DOI: 10.1213/01.ANE.0000147519.82841.5E
- Watt J., Tricco A.C., Talbot-Hamon C., et al. Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis. BMC Med. 2018; 12, 16(1): 2. DOI: 10.1186/s12916-017-0986-2
- Van Diepen S., Bakal J.A., Mcalister F.A., et al. Mortality and readmission of patients with heart failure, atrial fibrillation, or coronary artery disease undergoing noncardiac surgery: an analysis of 38 047 patients. Circulation. 2011; 124: 289–296. DOI: 10.1161/CIRCULATIONAHA.110.011130
- Mangano D.T., Browner W.S., Hollenberg M., et al. Long-term cardiac prognosis following noncardiac surgery. The Study of Perioperative Ischemia Research Group. JAMA. 1992; 268: 233–239. DOI: 10.1001/jama.268.2.233
- Guralnik J.M., Ershler W.B., Schrier S.L., Picozzi V.J. Anemia in the elderly: a public health crisis in hematology. ASH Educ Program Book. 2005; 2005: 528–532. DOI: 10.1182/asheducation-2005.1.528
- Koch C.G., Li L., Sun Z., et al. Hospital-acquired anemia: prevalence, outcomes, and healthcare implications. J Hosp Med. 2013; 8: 506–512. DOI: 10.1002/jhm.2061
- Chrastil J., Anderson M.B., Stevens V., et al. Is Hemoglobin A1c or Perioperative Hyperglycemia Predictive of Periprosthetic Joint Infection or Death Following Primary Total Joint Arthroplasty? J Arthroplasty. 2015; 30: 1197–1202. DOI: 10.14423/SMJ.0000000000000381
- Hachenberg T., Schneemilch C. Anesthesia in neurologic and psychiatric diseases: is there a ‘best anesthesia’ for certain diseases? Curr Opin Anaesthesiol. 2014; 27(4): 394–402. DOI: 10.1097/ACO.0000000000000098
- Kristensen S.D., Knuuti J., Saraste A., et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014; 35(35): 2383–431. DOI: 10.1093/eurheartj/ehu282
- Jammer I., Wickboldt N., Sander M., et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol. 2015; 32(2): 88–105. DOI: 10.1097/EJA.0000000000000118.
- Hackett N.J., Oliveira G.S., Jain U.K., Kim J.Y.S. ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg. 2015; 18: 184–90. DOI: 10.1016/j.ijsu.2015.04.079
- Kim M., Wall M., Li G. Risk Stratification for Major Postoperative Complications in Patients Undergoing Intra-abdominal General Surgery Using Latent Class Analysis. Anesth Analg. 2018; 126(3): 848–857. DOI: 10.1213/ANE.0000000000002345
- Козлов И.А., Овезов А.М., Пивоварова А.А. Снижение риска периоперационных осложнений при кардиальной коморбидности. Вестн. анестезиологии и реаниматологии. 2020; 17(2): 38–48. DOI: 10.21292/2078-5658-2020-17-2-38-48. [Kozlov I.A., Ovezov A.M., Pivovarova A.A. Snizheniye riska perioperatsionnykh oslozhneniy pri kardialnoy komorbidnosti. Vestnik anesteziologii i reanimatologii. 2020; 17(2): 38–48. (In Russ)]
- Gupta H., Ramanan B., Gupta P.K, et al. Impact of COPD on postoperative outcomes: results from a national database. Chest. 2013; 143(6): 1599–1606. DOI: 10.1378/chest.12-1499
- Lerman B.J., Popat R.A., Assimes T.L., et al. Association of Left Ventricular Ejection Fraction and Symptoms with Mortality After Elective Noncardiac Surgery Among Patients with Heart Failure. JAMA. 2019; 321(6): 572–579. DOI: 10.1001/jama.2019.0156
- Fransgaard T., Thygesen L.C., Gögenur I. Increased 30-day mortality in patients with diabetes undergoing surgery for colorectal cancer. Colorectal Dis. 2016; 18(1): O22-9. DOI: 10.1111/codi.13158
- Biccard B.M., Madiba T.E., Kluytset H.L., et al. Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. Lancet. 2018; 391(10130): 1589–1598. DOI: 10.1016/S0140-6736(18)30001-1
- Goffi L., Saba V., Ghiselli R., et al. Preoperative APACHE II and ASA scores in patients having major general surgical operations: Prognostic value and potential clinical applications. Eur J Surg. 1999; 165: 730–5. DOI: 10.1080/11024159950189483
- Hightower C.E., Riedel B.J., Feig B.W., et al. A pilot study evaluating predictors of postoperative outcomes after major abdominal surgery: Physiological capacity compared with the ASA physical status classification system. Br J Anaesth. 2010; 104: 465–71. DOI: 10.1093/bja/aeq034
- Makary M.A., Segev D.L., Pronovost P.J., et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010; 210: 901–8. DOI: 10.1016/j.jamcollsurg.2010.01.028
- Visnjevac O., Davari-Farid S., Lee J., et al. The Effect of Adding Functional Classification to ASA Status for Predicting 30-Day Mortality. Anesth Analg. 2015; 121: 110–6. DOI: 10.1213/ANE.0000000000000740
- Adham M., Bredt L.C., Robert M., et al. Pancreatic resection in elderly patients: should it be denied? Arch Surg. 2014; 399: 449–459. DOI: 10.1007/s00423-014-1183-9
- Lahat G., Sever R., Lubezky N., et al. Pancreatic cancer: surgery is feasible therapeutic option for elderly patients. World J Surg Oncol. 2011; 9: 10. DOI: 10.1186/1477-7819-9-10
- Козлов И.А., Овезов А.М., Петровская Э.Л. Периоперационное повреждение миокарда и сердечная недостаточность в некардиальной хирургии (обзор). Часть 1. Этиопатогенез и прогнозирование периоперационных кардиальных осложнений. Общая реаниматология. 2019; 15(2): 53–78. DOI: 10.15360/1813-9779-2019-2-53-78. [Kozlov I.A., Ovezov A.M., Petrovskaya E.L. Perioperatsionnoye povrezhdeniye miokarda i serdechnaya nedostatochnost v nekardialnoy khirurgii (obzor). Chast 1. Etiopatogenez i prognozirovaniye perioperatsionnykh kardialnykh oslozhneniy. Obshchaya reanimatologiya. 2019; 15(2): 53–78. (In Russ)]
- Сумин А.Н. Новое в оценке риска и лечении кардиальных осложнений при некардиальных операциях. Комплексные проблемы сердечно-сосудистых заболеваний. 2019; 8(2): 143–144. DOI: 10.17802/2306-1278-2019-8-2-143-144. [Sumin A.N. Novoye v otsenke riska i lechenii kardialnykh oslozhneniy pri nekardialnykh operatsiyakh. Kompleksnyye problemy serdechno-sosudistykh zabolevaniy. 2019; 8(2): 143–144. (In Russ)]
- Noordzij P.G., Poldermans D., Schouten O., et al. Postoperative mortality in The Netherlands: a population-based analysis of surgery-specific risk in adults. Anesthesiology. 2010; 112: 1105–15. DOI: 10.1097/ALN.0b013e3181d5f95c
- Pearse R.M., Moreno R.P., Bauer P., Pelosi P. Mortality after surgery in Europe: a 7 day cohort study. Lancet. 2012; 380(9847): 1059–65. DOI: 10.1016/S0140-6736(12)61148-9
- Wolters U., Wolf T., Stützer H., Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996; 77(2): 217–22. DOI: 10.1093/bja/77.2.217
- Irita K., Kawashima Y., Tsuzaki K., et al. Perioperative mortality and morbidity in the year 2000 in 502 Japanese certified anesthesia-training hospitals: with a special reference to ASA-physical status-report of the Japan Society of Anesthesiologists Committee on Operating Room Safety. Masui. 2002; 51(1): 71–85.
- Glance L.G., Lustik S.J., Hannan E.L., et al. The Surgical Mortality Probability Model: derivation and validation of a simple risk prediction rule for noncardiac surgery. Ann Surg. 2012; 255(4): 696–702. DOI: 10.1097/SLA.0b013e31824b45af
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