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.
INTRODUCTION. The need for accurate risk stratification is obvious. Modern methods are quite cumbersome, which can cause difficulties when applied in routine practice, and therefore relatively simple but accurate forecasting methods have become very popular, which, however, have not been validated in Russia: SORT (Surgical Outcome Risk Tool), SRS (Surgical Risk Scale), POSPOM (Preoperative Score to Predict Postoperative Mortality), NZRISK (New Zealand RISK), SMPM (Surgical Mortality Probability Model). OBJECTIVES. The aim of this work is to determine the prognostic value of risk assessment scales in predicting an unfavorable postoperative outcome based on the analysis of data obtained in the STOPRISK study in patients undergoing open abdominal surgery. MATERIALS AND METHODS. The analysis of data on perioperative parameters of 1,179 patients who underwent open abdominal surgery is presented. RESULTS. The fatal outcome was recorded in 14 patients (1.18 %). A total of 135 complications were registered in 92 patients (7.8 %). All scales demonstrated satisfactory prognostic value in assessing the risk of complications (the area under the operating characteristic curve (AUROC) for the Physical Status Scale of the American Society of Anesthesiologists (ASA) was 0.714 (0.687-0.739), for the Surgical Risk Scale (SRS) - 0.727 (0.701-0.753), for the Surgical Outcome Risk Scale (SORT) - 0.738 (0.712-0.763), for the New Zealand Risk Scale (NZRISK) - 0.763 (0.738-0.787)), for the Surgical Mortality Probability Scale (SMPM) - 0.732 (0.706-0.757), for the Preoperative Postoperative mortality Prediction Scale (POSPOM) - 0.764 (0.738-0.788)) and good in assessing the risk of death (AUROC for the ASA scale was 0.82 (0.804-0.843), for the SRS scale - 0.860 (0.838-0.879), for the SORT scale - 0.860 (0.838-0.879), for the NZRISK scale - 0.807 (0.783-0.829), for the SMPM scale - 0.852 (0.831-0.872), for the POSPOM scale - 0.811 (0.788-0.833)). CONCLUSIONS. All the studied scales have good prognostic value in assessing the risk of 30-day mortality after major abdominal surgery. The NZRISK and POSPOM scales demonstrate good prognostic value for cardiovascular complications, POSPOM and SRS scales - for acute renal injury. POSPOM and NZRISK scales showed an excellent prognostic value in relation to the risk of postoperative delirium.
INTRODUCTION: Advances in modern anesthesiology have significantly reduced the risk of anesthesia compared to the last century, however, the level of perioperative in-hospital mortality after elective major abdominal surgery is still high at the moment. Poor outcome prediction is the cornerstone of individualized perioperative management of high-risk patients aimed at preventing complications. Despite the fact that a large number of risk assessment tools have been developed over the past decades, the accuracy of the forecast is still far from required. According to the literature data, models based on the study of risk factors in the national population of patients, of which comorbidities make the greatest contribution, have the greatest accuracy. MATERIALS AND METHODS: Design: prospective observational study. Setting: National multicenter study of patients in surgical hospitals. Patients: Patients undergoing abdominal surgery. Interventions: Not provided. RESULTS: The developed design was registered in the ClinicalTrials.gov database, a study organized by the Federation of Anesthesiologists and Resuscitators of Russia in cooperation with the Kuban State Medical University has now begun, 38 centers are participating in it, two papers have been published based on the results of an interim analysis. CONCLUSIONS: The study is of great scientific and medical and social importance, as a result of the analysis of the data obtained, the role of concomitant diseases in the development of an adverse outcome will be studied and a national risk assessment model will be developed. REGISTRATION: Clinicaltrials.gov identifier: NCT03945968. Registered May 10, 2019.
Diabetes mellitus is a proven predictor of postoperative complications, especially infectious and cardiac, and also significantly increases the risk of mortality. The article presents a revision of the national guidelines of the Federation of Anesthesiologists and Reanimatologists (FAR) on the perioperative management of adult patients with diabetes mellitus, which summarizes and evaluates all available data at the time of revision on this topic. The literature search was focused on meta-analyses and randomized controlled trials, but also included registries, non-randomized comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinions. Before publication, the guidelines were approved by the Presidium of the FAR Board. In the revised version of 2022, changes were made in comparison with the previous one: the preoperative diagnosis of cardiac autonomic neuropathy using a deep breathing test and an orthostatic test was justified, the principles of elective surgery canceling depending on the level of glycated hemoglobin and the tactics of preoperative oral hypoglycemic drugs prescribing were presented. The choice between general and regional anesthesia based on the detection of cardiac autonomic neuropathy and polyneuropathy was also justified, the choice of drugs for anesthesia and the principles of their dosing were reasoned, antiemetic therapy was determined. For each recommendation, the level of evidence is presented. The guidelines were developed by experts in the field of perioperative management of patients for anesthesiologists and intensive care specialists to help in decision-making, the final decisions concerning an individual patient must be made by the by the attending physician after consultation with an endocrinologist and/or based on the decision of the council of specialists.
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