Usefulness of pre- and intraoperative risk scores in nonagenarian surgical patients

Autor:	Manuel Artiles-Armas, Roberto Fariña-Castro, Joaquín Marchena-Gómez, Cristina Roque-Castellano, Alicia Conde-Martel
Rok vydání:	2020
Předmět:	medicine.medical_specialty Population Risk Assessment 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors 030202 anesthesiology Anesthesiology medicine Humans education Retrospective Studies Aged 80 and over Univariate analysis education.field_of_study Receiver operating characteristic business.industry Postoperative complication 030208 emergency & critical care medicine Surgery Anesthesiology and Pain Medicine ROC Curve Anesthesia Female Apgar score Morbidity business Complication Surgical patients
Zdroj:	Journal of Anesthesia. 34:650-657
ISSN:	1438-8359 0913-8668
DOI:	10.1007/s00540-020-02799-3
Popis:	Preoperative assessment at extreme ages would identify patients at a high risk of developing postoperative complications. The objective of this study was to compare the usefulness of different risk scales in a series of nonagenarian surgical patients.A total of 244 surgical nonagenarians, 148 women (60.7%), median age 91 years (IQR: 90-93), were analysed. The following scales were evaluated: preoperative status (ASA-PS, Charlson Comorbidity Index, Lee Index, Reiss Index, and surgical mortality probability model-S-MPM); intraoperative status (Surgical Apgar Score and SASA score), and, as output variables, surgical outcomes (morbidity measured by the Comprehensive Complication Index-CCI, and death). Univariate analysis and receiver operating characteristic curves (ROC) were performed. Area under ROC curves (AUROC) were evaluated to define the best predictors of poor outcomes.Operative mortality was 27.0%, and 73.4% presented some type of postoperative complication. Operative mortality was associated with the ASA-PS score (p 0.001), Reiss Index (p 0.001), Lee Index (p = 0.010), S-MPM (p 0.001), Surgical Apgar Score (p 0.001), SASA score (p 0.001), and emergency surgery (p 0.001). Postoperative complications were related to the ASA-PS score (p = 0.001), Reiss Index (p 0.001), Lee Index (p 0.001), S-MPM (p 0.001), Surgical Apgar Score (p 0.001) and SASA score (p 0.001). The best predictors of operative mortality and complications were the SASA and Surgical Apgar Score (AUROCs 0.88).As in the general population, the Surgical Apgar Score and SASA score are the best predictors of operative mortality and morbidity in nonagenarian patients. These risk scales should be considered in the perioperative management of these patients.
Databáze:	OpenAIRE
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