A comparative analysis of Charlson's weighted index of comorbidity and perforated peptic ulcer scores in predicting postoperative mortality and high comprehensive complication index.

Autor: Lim RZM; Department of General Surgery, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia.; Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia (National University of Malaysia), Bangi, Selangor, Malaysia., Tan JH; Department of General Surgery, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia., Raja Ram NK; Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia., Tan HCL; Department of General Surgery, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia., Ho IKE; Department of General Surgery, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia.; Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia (National University of Malaysia), Bangi, Selangor, Malaysia., Chuah JS; Department of General Surgery, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia.; Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia (National University of Malaysia), Bangi, Selangor, Malaysia., Mahendran HA; Department of General Surgery, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia.
Jazyk: angličtina
Zdroj: World journal of surgery [World J Surg] 2024 Jun; Vol. 48 (6), pp. 1373-1384. Date of Electronic Publication: 2024 Apr 02.
DOI: 10.1002/wjs.12162
Abstrakt: Background: Limited data exists on Charlson's weighted index of comorbidity (WIC) predictability for postoperative outcomes following perforated peptic ulcer (PPU) surgery. This study assesses the utility of WIC and other predictive scores in forecasting both postoperative mortality and morbidity in PPU.
Materials & Methods: Patients with PPUs operated between 2018 and 2021 in a Malaysian tertiary referral center were included. Clinical data were retrospectively analyzed for association with mortality and morbidity measured with the Comprehensive Complication Index (CCI). Predictability of WIC and other predictors were examined using area under receiver-operator characteristic (ROC) curve (AUC).
Results: Among 110 patients included, 18 died (16.4%) and 36 (32.7%) had significant morbidity postoperatively (High CCI, ≥26.2). Both mortality and high CCI were associated with age >65 years, female sex, comorbidities (diabetes mellitus, hypertension, and renal disease), and American Society of Anesthesiologist score >2. Most patients who died had renal dysfunction, metabolic acidosis, lactate >2 mmol/L upon presentation preoperatively. While surgery >24 h after presentation correlated with mortality and high CCI, the benefit of earlier surgery <6 h or <12 h was not demonstrated. WIC (AUC, 0.89; 95% CI, 0.81-0.99) showed similar predictability to Peptic Ulcer Perforation (PULP) (AUC, 0.97; 95% CI, 0.93-1.00) for mortality. PULP effectively predicted high CCI (AUC, 0.83; 95% CI, 0.73-0.93; p < 0.001).
Conclusion: WIC is valuable in predicting mortality, highlighting the importance of comorbidity in risk assessment. PULP score was effective in predicting both mortality and high CCI. Early identification of patients with high perioperative risk will facilitate patients' triage for escalated care, leading to a better outcome.
(© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)
Databáze: MEDLINE
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