Title
The predictive performance of the POSSUM scoring system and early indicatosrs of peripheral perfusion for complications after major abdominal surgery
Creator
Veličković, Jelena, 1975-, 18260327
Copyright date
2019
Object Links
Select license
Autorstvo-Nekomercijalno-Bez prerade 3.0 Srbija (CC BY-NC-ND 3.0)
License description
Dozvoljavate samo preuzimanje i distribuciju dela, ako/dok se pravilno naznačava ime autora, bez ikakvih promena dela i bez prava komercijalnog korišćenja dela. Ova licenca je najstroža CC licenca. Osnovni opis Licence: http://creativecommons.org/licenses/by-nc-nd/3.0/rs/deed.sr_LATN. Sadržaj ugovora u celini: http://creativecommons.org/licenses/by-nc-nd/3.0/rs/legalcode.sr-Latn
Language
English
Cobiss-ID
Theses Type
Doktorska disertacija
description
Datum odbrane: 02.10.2019.
Other responsibilities
mentor
Bumbaširević, Vesna, 1955-, 12434023
član komisije
Palibrk, Ivan, 1964-, 13797735
član komisije
Simić, Aleksandar P., 1965-, 12702567
član komisije
Jovanović, Bojan, 1972-, 35052135
član komisije
Grasselli, Giacomo, 28731751
član komisije
Bellani, Giacomo, 36059239
Academic Expertise
Medicinske nauke
University
Univerzitet u Beogradu
Faculty
Medicinski fakultet
Alternative title
Značaj POSSUM skora i ranih pokazatelja periferne perfuzije za predviđanje postoperativnih komplikacija u hirurgiji digestivnog sistema
Publisher
[J. Veličković]
Format
148 listova
description
Medicine - Anesthesiology / Medicina - Anesteziologija
Abstract (en)
Postoperative complications are the major cause of postoperative morbidity and mortality and remain to be a serious burden for a healthcare system. The early identification of patients at risk may play a pivotal role in rational decisions regarding perioperative management. The aim of this study was to explore the characteristics of complications in high-risk patients after major abdominal surgery. We also assessed and compared the accuracy of the Clavien-Dindo classification (CDC) and the Comprehensive Complication Index (CCI) for evaluation of postoperative morbidity and the predictive performance of the POSSUM scoring system for complications and mortality. Finally, we wanted to explore the significance of early indicators of altered peripheral perfusion after major abdominal surgery for the occurrence of severe complications.
A prospective, observational, cohort study included 206 high-risk surgical patients undergoing major abdominal surgery at the Clinic for Digestive Surgery, Clinical Center of Serbia, from November 2016 to October 2017.
We found that the complication rate in our cohort was 60.7% and that the occurrence of complications was associated with the longer ICU stay (p<0.001), postoperative length of stay (p<0.001) and lower functional activity at hospital discharge (p<0.001). The CCI was shown to be of superior accuracy in high-risk patients with multiple complications compared to the CDC as it demonstrated a higher correlation to the resource utilization indicators (p<0.001). The POSSUM scoring system showed the sub-optimal performance for prediction of morbidity and mortality in this cohort of patients (AUCmorbidity= 0.708, O:E ratio=1.07; AUCmortality= 0.744, O:E ratio=0.38). We found that the alterations of peripheral perfusion early after the operation were more pronounced in patients who developed more severe complications. Capillary refill time, central-to-peripheral temperature gradient, and venoarterial pCO2 difference to arteriovenous O2 content ratio on admission to the ICU after the operation, as well as serum lactate concentration and base excess 12 hours after the admission to the ICU were the independent predictors of severe complications. Finally, based on the preoperative, intraoperative, and postoperative variables, with the application of the machine learning algorithms, we developed a new model for the prediction of postoperative complications. The model was validated on the new set of patients and it demonstrated an excellent predictive performance (AUC=0.91; sensitivity 92%; specificity 78%; PPV 87%).
Abstract (sr)
Postoperativne komplikacije su vodeći uzrok postoperativnog morbiditeta i mortaliteta i predstavljaju značajno opterećenje za zdravstveni sistem u celini. Rana identifikacija bolesnika sa povećanim rizikom može imati ključnu ulogu u donošenju racionalnih odluka u vezi sa perioperativnim lečenjem. Cilj ove studije bio je da ispita karakteristike komplikacija kod visokorizičnih bolesnika nakon velike abdominalne hirurgije. Takođe smo procenili i uporedili preciznost Clavien-Dindo klasifikacije (CDC) i Comprehensive Complication Index-a (CCI) za evaluaciju postoperativnog morbiditeta i ispitali prediktivne karakteristike POSSUM skora za komplikacije i mortalitet. Konačno, analizirali smo značaj ranih pokazatelja periferne perfuzije za pojavu teških komplikacija nakon velike abdominalne hirurgije.
Prospektivna, opservaciona, kohortna studija pratila je 206 visokorizičnih bolesnika podvrgnutih velikoj abdominalnoj operaciji na Klinici za digestivnu hirurgiju Kliničkog centra Srbije, od novembra 2016 do oktobra 2017.godine.
Pokazali smo da je učestalost komplikacija u našoj kohorti bila 60.7% i da je pojava komplikacija bila udružena sa dužim boravkom u jedinici intenzivnog lečenja (JIL) (p< 0.001), dužom postoperativnom hospitalizacijom (p<0.001) i nižim funkcionalnim kapacitetom na otpustu iz bolnice (p<0.001). Takođe je prikazano da je CCI prikladnija skala za visokorizične bolesnike sa udruženim komplikacijama u poređenju sa CDC jer je ispoljila jaču korelaciju sa parametrima hospitalizacije (p<0.001). POSSUM skor je pokazao suboptimalne karakteristike u predviđanju rizika za morbiditet i mortalitet u ovoj kohorti bolesnika (AUCmorbiditet = 0.708, O:E odnos = 1.07; AUCmortalitet = 0.744, O:E odnos =0.38). Poremećaj periferne perfizije rano nakon operacije bio je izraženiji kod onih bolesnika kod kojih su se razvile teže komplikacije. Kao nezavisni prediktori teških komplikacija su se izdvojili vreme kapilarnog punjenja, centralno-periferni gradijent temperature i odnos venoarterijske razlike pCO2 i arteriovenske razlike u sadržaju kiseonika na prijemu u JIL nakon operacije, kao i serumska koncentracija laktata i bazni eksces 12 sati nakon operacije. Konačno, na osnovu preoperativnih, intraoperativnih i postoperativnih varijabli, primenom algoritama mašinskog učenja, kreirali smo novi model za predviđanje postoperativnih komplikacija. Model je eksterno validiran i pokazao je odlične prediktivne karakteristike (AUC = 0.91; senzitivnost 92%; specifičnost 78%; pozitivna prediktivna vrednost 87%).
Authors Key words
major abdominal surgery; postoperative complications; peripheral perfusion; POSSUM score
Authors Key words
elika abdominalna hirurgija; postoperativne komplikacije; periferna perfuzija; POSSUM skor
Classification
616-089(043.3)
Type
Tekst
Abstract (en)
Postoperative complications are the major cause of postoperative morbidity and mortality and remain to be a serious burden for a healthcare system. The early identification of patients at risk may play a pivotal role in rational decisions regarding perioperative management. The aim of this study was to explore the characteristics of complications in high-risk patients after major abdominal surgery. We also assessed and compared the accuracy of the Clavien-Dindo classification (CDC) and the Comprehensive Complication Index (CCI) for evaluation of postoperative morbidity and the predictive performance of the POSSUM scoring system for complications and mortality. Finally, we wanted to explore the significance of early indicators of altered peripheral perfusion after major abdominal surgery for the occurrence of severe complications.
A prospective, observational, cohort study included 206 high-risk surgical patients undergoing major abdominal surgery at the Clinic for Digestive Surgery, Clinical Center of Serbia, from November 2016 to October 2017.
We found that the complication rate in our cohort was 60.7% and that the occurrence of complications was associated with the longer ICU stay (p<0.001), postoperative length of stay (p<0.001) and lower functional activity at hospital discharge (p<0.001). The CCI was shown to be of superior accuracy in high-risk patients with multiple complications compared to the CDC as it demonstrated a higher correlation to the resource utilization indicators (p<0.001). The POSSUM scoring system showed the sub-optimal performance for prediction of morbidity and mortality in this cohort of patients (AUCmorbidity= 0.708, O:E ratio=1.07; AUCmortality= 0.744, O:E ratio=0.38). We found that the alterations of peripheral perfusion early after the operation were more pronounced in patients who developed more severe complications. Capillary refill time, central-to-peripheral temperature gradient, and venoarterial pCO2 difference to arteriovenous O2 content ratio on admission to the ICU after the operation, as well as serum lactate concentration and base excess 12 hours after the admission to the ICU were the independent predictors of severe complications. Finally, based on the preoperative, intraoperative, and postoperative variables, with the application of the machine learning algorithms, we developed a new model for the prediction of postoperative complications. The model was validated on the new set of patients and it demonstrated an excellent predictive performance (AUC=0.91; sensitivity 92%; specificity 78%; PPV 87%).
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