Possibilities of preoperative assessment of the risk of an adverse outcomes after abdominal surgery: preliminary results of the multicenter STOPRISK study

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.

Posthospital Cardiovascular Complications in Patients after Non-Cardiac Surgery

“…Вместе с тем данные о наличии сердечно-сосудистой коморбидности у хирургических больных варьируют в достаточно широких пределах в зависимости от националь ной принадлежности и дизайна исследований, а также особенностей проанализированных когорт больных. По данным отечественных клиницистов, частота сопутствующей ИБС составляет около 20%, ХСН -26,3%, ГБ -14,2-35,2%, диабета 10,2-15,0%, инсульта -около 2% [4,10]. Указывают, что для больных с послеоперационными кардиальными осложнениями характерна максимально высокая частота сопутствующей ГБ (до 70%) [1].…”

“…Не описаны факто ры риска таких осложнений. Большинство индексов кардиального риска (ИКР), рекомендованных для широкого использования [4,17], ориентированы на кардиальные осложнения госпитального и/или в 30-суточного послеоперационного периода. Валид ность этих ИКР для прогнозирования отдаленных послеоперационных осложнений также остается неизученной.…”