Annales Academiae Medicae Stetinensis · 2010
[Early death in vascular surgery: an ongoing prognostic problem].
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Kazimierczak Arkadiusz, Sledź Marcin, Guzicka-Kazimierczak Renata, Gutowski Piotr, Cnotliwy Miłosław
Аннотация
INTRODUCTION: Prediction of complications in surgery is commonly done. There are conflicting reports concerning the usefulness of risk scales (P-POSSUM, APACHE, SAPS, ASA, Goldman, etc.) in vascular surgery. We decided to take a fresh look at preoperative risk factors of early death in the context of the usefulness of some parameters which have not been included in existing risk calculators.
MATERIAL AND METHODS: The study group consisted of 1270 patients treated at the Department of Vascular Surgery, General Surgery, and Angiology, Pomeranian Medical University in Szczecin, during one year. METHOD This was a prospective non-randomized study. All data recorded at admission and data from P-POSSUM, ASA, Goldman, and ECOG-Zubroda-WHO scales were analyzed. Statistics were done with discriminant, multivariate, and logistic tests.
RESULTS: There were 42 early deaths in the group. The following independent risk factors were involved in early death: ASA > 2 (OR = 18.31), persistent atrial fibrillation (OR = 5.75), leukocytosis (OR = 13.31), glomerular filtration rate (GFR) < 30 mL/min/1.73 m2 (OR = 5.78), systemic inflammatory response syndrome (SIRS) (OR = 11.36), emergency admission (OR = 38.62), critical limb ischemia (OR = 4.87), acute limb ischemia (OR = 8,98), abdominal aortic aneurysm (OR = 4.4), and ruptured aortic aneurysm (OR = 10.59). Logistic regression exposed the influence of five factors: ASA III, ASA IV, persistent atrial fibrillation, leukocytosis, GFR < 30 mL/kg/1.73 m2, and ruptured aortic aneurysm. The P-POSSUM calculator was found to be an accurate predictor of early death although the predicted death rate was insignificantly higher than the observed rate.
CONCLUSION: Risk scales of early death currently used in vascular surgery need to be "refreshed". Creation of the Polish National Vascular Surgery Register seems to be unavoidable.
MATERIAL AND METHODS: The study group consisted of 1270 patients treated at the Department of Vascular Surgery, General Surgery, and Angiology, Pomeranian Medical University in Szczecin, during one year. METHOD This was a prospective non-randomized study. All data recorded at admission and data from P-POSSUM, ASA, Goldman, and ECOG-Zubroda-WHO scales were analyzed. Statistics were done with discriminant, multivariate, and logistic tests.
RESULTS: There were 42 early deaths in the group. The following independent risk factors were involved in early death: ASA > 2 (OR = 18.31), persistent atrial fibrillation (OR = 5.75), leukocytosis (OR = 13.31), glomerular filtration rate (GFR) < 30 mL/min/1.73 m2 (OR = 5.78), systemic inflammatory response syndrome (SIRS) (OR = 11.36), emergency admission (OR = 38.62), critical limb ischemia (OR = 4.87), acute limb ischemia (OR = 8,98), abdominal aortic aneurysm (OR = 4.4), and ruptured aortic aneurysm (OR = 10.59). Logistic regression exposed the influence of five factors: ASA III, ASA IV, persistent atrial fibrillation, leukocytosis, GFR < 30 mL/kg/1.73 m2, and ruptured aortic aneurysm. The P-POSSUM calculator was found to be an accurate predictor of early death although the predicted death rate was insignificantly higher than the observed rate.
CONCLUSION: Risk scales of early death currently used in vascular surgery need to be "refreshed". Creation of the Polish National Vascular Surgery Register seems to be unavoidable.