Correlação entre os escores Surgical Risk Calculator e Safety Zone no pré-operatório de cirurgias não cardíacas

Contexto: A TEV é uma complicação comum em pacientes hospitalizados. Assim, a estratificação do risco tromboembólico é essencial para minimizar complicações e otimizar a condição pré-operatória do paciente antes de cirurgias eletivas. Objetivo:Investigar a correlação entre o escore ACS NSQIP Surgical Risk Calculator e o TEV Safety Zone na avaliação ambulatorial pré-operatória do risco tromboembólico em cirurgias não cardíacas.Métodos: Estudo observacional transversal retrospectivo com análise de prontuários eletrônicos de pacientes atendidos em um ambulatório multidisciplinar de medicina e enfermagem perioperatória no período compreendido entre Janeiro e Dezembro de 2017. Correlacionou-se o escore de risco tromboembólico TEV Safety Zone já aplicado no ambulatório com o risco de tromboembolismo venoso obtido pela calculadora de risco ACS NSQIP Surgical Risk Calculator. Resultados:Foi coletada uma amostra de 416 prontuários. Destes, 197 (47,6%) resultaram em risco equivalente entre os dois escores e 219 divergiram nos resultados. Obteve-se um p<0,001 através do teste de Wilcoxon.Conclusões: Houve correlação entre o ACS NSQIP Surgical Risk Calculator e o TEV Safety Zone (p<0,001).

ACS NSQIP Surgical Risk Calculator e escores IRCR de Lee e ACP/Detsky: avaliação pré-operatória cardiovascular

Introdução: os eventos cardíacos pré e pós-operatórios são a maior causa de morbidade e mortalidade em cirurgias eletivas não cardíacas. Assim, a estratificação de risco cardiovascular pré operatória é essencial para identificar o risco e minimizar suas possíveis complicações. Objetivo: investigar a correlação entre o escore ACS NSQIP Surgical Risk Calculator e os escores tradicionalmente utilizados (ACP modificado por Detsky e IRCR por Lee) na avaliação ambulatorial pré-operatória do risco cardiovascular em cirurgias não cardíacas. Métodos: estudo observacional transversal retrospectivo com análise de registros eletrônicos de pacientes atendidos em um ambulatório multidisciplinar de medicina e enfermagem Perioperatória no período compreendido entre janeiro e dezembro de 2017. Correlacionou-se o escore de risco cardiovascular de Lee e ACP/Detsky já aplicado no ambulatório com o risco cardíaco obtido pela calculadora de risco ACS NSQIP Surgical Risk Calculator. Resultados: foi coletada uma amostra de 416 prontuários. Destes, 195 (47%) resultaram em risco equivalente entre os dois escores e 221 casos divergiram nos resultados. Obteve-se um p<0,001 através do teste de Wilcoxon. Conclusões: houve correlação entre o ACS NSQIP Surgical Risk Calculator e os escores de Lee e ACP/Detsky (p<0,001).

Infectious Complications Following Radical Cystectomy: A Structural Equation Model

Objective: To use factor analysis to structure items from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) into latent variables associated with infectious complications, and then to use structural equation modeling (SEM) to organize those latent variables into a predictive model of POIC. Predictive models of post-operative infectious complications (POIC) have traditionally relied upon logistic regression and inconsistent variable groupings. A more standardized approach to a valid construct would allow for more unitary research and improved clinical decision making. Materials and Methods: The study evaluated data from 1580 recipients of radical cystectomies in the ACS NSQIP PUF 2013 database. Pre-operative, operative, and post-operative data were analyzed. Exploratory Factor Analysis (EFA) and theory-based selection were used to create latent variables for a predictive model of POIC which was analyzed with structural equation modeling.Results: After reducing unrelated variables using EFA, two latent variables successfully predicted POIC, a Global Health Variable (Dyspnea, COPD, Diabetes, and Hypertension) and a Proximal Pre-operative Infectious Comorbidity Variable (pre-operative transfusion, pre-operative wound infection, and pre-operative sepsis). The final model produced was well-fit and suggest two unique pathway indicators for understanding which patients are at higher risk for POIC.Conclusion: Discerning the most significant items and their role in the POIC model offer clinical insight into adverse events and new considerations into the prevention of such events. Patients endorsing multiple items in the model may benefit from pre-operative optimization of modifiable conditions and closer post-operative surveillance.

A Comparison of Outcomes Between Laparoscopic and Robotic Appendectomy Among ACS NSQIP Hospitals

Background/Objective: Robotic general surgery remains controversial with some employing the technology for common laparoscopic procedures such as appendectomies. Very few studies have compared robotic appendectomies to existing techniques, partly due to the relative scarcity of data. The purpose of this study was to compare outcomes for robotic appendectomies versus laparoscopic appendectomies. Methods: This retrospective cohort study evaluated procedural specific databases of ACS-NSQIP for appendectomy between 2016-2019 (inclusive). Demographic and surgical outcomes including composite 30 day complications, specific complications, and length of operation were analyzed using a univariant analysis. Results: There was no difference in the total number of comorbidities present or the severity of appendicitis (perforation/abscesses) between robotic and laparoscopic cases. Robotic appendectomy had a longer operation time (91 min vs 52 min, p < 0.001) but a shorter post-operative stay (0.66 days vs 1.27 days, p < 0.001). There was no difference in the frequency of 30-day mortality (p = 0.34), readmission (p = 0.20), or complications (p = 1) between robotically performed appendectomy and laparoscopic appendectomy (Table 1) Laparoscopic Robotic Complications N = 49,800 N = 50 P Value Odds ratio Any Complication 5302 (10.6%) 5 (10%) 1 1.06 Superficial surgical site infection 423 (0.8%) 0 >0.9 Organ Space SSI 1,355 (2.7%) 0 >0.9 Postoperative Intra-abdominal Abscess 1353 (2.7%) 0 >0.9 Sepsis 1,696 (3.4%) 1 (2%) >0.9 1.7 Table 1. Complications for Laparoscopic versus Robotic appendectomy. Conclusion and Potential Impact: Our results demonstrated laparoscopic and robotic appendectomy had a similar frequency and profile of complications. Robotic procedures took longer but resulted in shorter post-operative stays. Robotic appendectomies appear promising but at present, only make up a small fraction of cases (0.1%) and the widespread adoption of robotic appendectomies is difficult due to issues of cost, equipment, and training.

P-EGS17 Evaluation of Different Surgical Risk Prediction Models in Predicting Morbidity and Mortality in Emergency Giant Hiatus and Diaphragmatic Hernia Repairs

Background Emergency presentation of giant hiatus and diaphragmatic hernias are associated with significant morbidity and mortality, and predicting perioperative risks can be difficult. There are several preoperative risk evaluation models used commonly in emergency general surgery. Not only can they help clinicians stratify risk, but they can also be valuable tools to outline surgical risks to patients and families. This study aimed to evaluate the suitability of different risk prediction models when predicting morbidity and mortality in emergency giant hiatus and diaphragmatic hernia repairs. Methods This was a retrospective cohort study of all emergency hiatus and diaphragmatic hernia repairs at a tertiary upper gastrointestinal centre from 2010 to 2021. The outcomes were compared to the predicted mortality and morbidity of different risk prediction models. The mortality models SORT (Surgical Outcome Risk Tool), NELA (National Emergency Laparotomy Audit) and ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Programme) were compared using the area under the curve (AUC). Morbidity was evaluated by calculating the comprehensive complication index (CCI). CCI was compared to P-POSSUM (Portsmouth – Physiological and Operative Severity Score) and ACS-NSQIP predicted morbidity using Spearman correlation. Results 108 patients were included in the analysis. 49.1% were female, and 50.9% were male. The median age was 69 (IQR 59-78). The 30-day mortality rate was 6.93%. ACS-NSQIP had the highest predictive power for mortality (AUC = 0.845), in comparison to NELA (AUC=0.809) and SORT (AUC = 0.740). Both ACS-NSQIP and P-POSSUM showed moderate correlation to CCI (rho = 0.489, p &lt; 0.001 and 0.446, p &lt; 0.001 respectively). Conclusions ACS-NSQIP is a better predictor of both mortality and morbidity in emergency giant hiatus and diaphragmatic hernia repairs when compared to NELA, P-POSSUM and SORT. ACS-NSQIP may have a role in pre-assessment and consenting of emergency giant hiatus and diaphragmatic hernia repairs. Multi-centre prospective studies could be used to validate these findings.