[CR-POSSUM and Surgical Apgar Score as predictive factors for patients' allocation after colorectal surgery]

Detalhes bibliográficos
Autor(a) principal: Pinho, S.
Data de Publicação: 2018
Outros Autores: Lagarto, F., Gomes, B., Costa, L., Nunes, C., Oliveira, C.
Tipo de documento: Artigo
Idioma: por
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10400.16/2324
Resumo: Background and objectives: Surgical patients frequently require admission in high-dependency units or intensive care units. Resources are scarce and there are no universally accepted admission criteria, so patients' allocation must be optimized. The purpose of this study was to investigate the relationship between postoperative destination of patients submitted to colorectal surgery and the scores ColoRectal Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (CR-POSSUM) and Surgical Apgar Score (SAS) and, secondarily find cut-offs to aid this allocation. Methods: A cross-sectional prospective observational study, including all adult patients undergoing colorectal surgery during a 2 years period. Data collected from the electronic clinical process and anesthesia records. Results: A total of 358 patients were included. Median score for SAS was 8 and CR-POSSUM had a median mortality probability of 4.5%. Immediate admission on high-dependency units/intensive care units occurred in 51 patients and late admission in 18. Scores from ward and high-dependency units/intensive care units patients were statistically different (SAS: 8 vs. 7, p<0.001; CR-POSSUM: 4.4% vs. 15.9%, p<0.001). Both scores were found to be predictors of immediate postoperative destination (p<0.001). Concerning immediate high-dependency units/intensive care units admission, CR-POSSUM showed a strong association (AUC 0.78, p=0.034) with a ≥9.16 cut-off point (sensitivity: 62.5%; specificity: 75.2%), outperforming SAS (AUC 0.67, p=0.048), with a ≤7 cut-off point (sensitivity: 67.3%; specificity: 56.1%). Conclusions: Both CR-POSSUM and SAS were associated with the clinical decision to admit a patient to the high-dependency units/intensive care units immediately after surgery. CR-POSSUM alone showed a better discriminative capacity.
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spelling [CR-POSSUM and Surgical Apgar Score as predictive factors for patients' allocation after colorectal surgery]Escore CR‐POSSUM e Índice de Apgar Cirúrgico como fatores preditivos para a alocação de pacientes após cirurgia colorretalCR‐POSSUMApgarTriagem pós‐operatóriaTerapia intensivaPostoperative triageIntensive careBackground and objectives: Surgical patients frequently require admission in high-dependency units or intensive care units. Resources are scarce and there are no universally accepted admission criteria, so patients' allocation must be optimized. The purpose of this study was to investigate the relationship between postoperative destination of patients submitted to colorectal surgery and the scores ColoRectal Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (CR-POSSUM) and Surgical Apgar Score (SAS) and, secondarily find cut-offs to aid this allocation. Methods: A cross-sectional prospective observational study, including all adult patients undergoing colorectal surgery during a 2 years period. Data collected from the electronic clinical process and anesthesia records. Results: A total of 358 patients were included. Median score for SAS was 8 and CR-POSSUM had a median mortality probability of 4.5%. Immediate admission on high-dependency units/intensive care units occurred in 51 patients and late admission in 18. Scores from ward and high-dependency units/intensive care units patients were statistically different (SAS: 8 vs. 7, p<0.001; CR-POSSUM: 4.4% vs. 15.9%, p<0.001). Both scores were found to be predictors of immediate postoperative destination (p<0.001). Concerning immediate high-dependency units/intensive care units admission, CR-POSSUM showed a strong association (AUC 0.78, p=0.034) with a ≥9.16 cut-off point (sensitivity: 62.5%; specificity: 75.2%), outperforming SAS (AUC 0.67, p=0.048), with a ≤7 cut-off point (sensitivity: 67.3%; specificity: 56.1%). Conclusions: Both CR-POSSUM and SAS were associated with the clinical decision to admit a patient to the high-dependency units/intensive care units immediately after surgery. CR-POSSUM alone showed a better discriminative capacity.Justificativa e objetivos Os pacientes cirúrgicos com frequência precisam de internação em unidade de alta dependência ou unidade de terapia intensiva. Os recursos são escassos e não há critérios de admissão universalmente aceitos; portanto, a alocação dos pacientes precisa ser aprimorada. O objetivo primário deste estudo foi investigar a relação entre o destino dos pacientes após cirurgia colorretal e o Índice de Apgar Cirúrgico (IAC) e o escore CR‐POSSUM – do inglês ColoRectal Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity – e, secundariamente, descobrir pontos de corte para auxiliar essa alocação. Métodos Estudo prospectivo de observação transversal, incluiu todos os pacientes adultos submetidos à cirurgia colorretal durante um período de dois anos. Os dados foram coletados do prontuário clínico eletrônico e dos registros de anestesia. Resultados Foram incluídos 358 pacientes. A mediana para o IAC foi 8 e para a probabilidade de mortalidade no CR‐POSSUM, 4,5%. A admissão imediata em unidade de alta dependência/unidade de terapia intensiva ocorreu em 51 pacientes e a admissão tardia em 18. Os escores dos pacientes na enfermaria e na unidade de alta dependência/unidade de terapia intensiva foram estatisticamente diferentes (tempo de internação: 8 vs. 7, p < 0,001; CR‐POSSUM: 4,4% vs. 15,9%, p < 0,001). Os dois escores foram preditivos do destino imediato pós‐cirurgia (p < 0,001). Em relação à admissão imediata em UAD/UTI, CR‐POSSUM mostrou uma forte associação (ASC 0,78; p = 0,034) com um ponto de corte ≥ 9,16 (sensibilidade: 62,5%; especificidade: 75,2%), superou o IAC (ASC 0,67, p = 0,048), com ponto de corte ≤ 7 (sensibilidade: 67,3%; especificidade: 56,1%). Conclusões Tanto o CR‐POSSUM quanto o IAC foram associados à decisão clínica de admitir um paciente em unidade de alta dependência/unidade de terapia intensiva imediatamente após a cirurgia. CR‐POSSUM isolado mostrou uma capacidade discriminativa melhor.ElsevierRepositório Científico do Centro Hospitalar Universitário de Santo AntónioPinho, S.Lagarto, F.Gomes, B.Costa, L.Nunes, C.Oliveira, C.2020-03-17T18:53:19Z20182018-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.16/2324porPinho S, Lagarto F, Gomes B, Costa L, Nunes CS, Oliveira C. Escore CR‐POSSUM e Índice de Apgar Cirúrgico como fatores preditivos para a alocação de pacientes após cirurgia colorretal [CR-POSSUM and Surgical Apgar Score as predictive factors for patients' allocation after colorectal surgery]. Rev Bras Anestesiol. 2018;68(4):351–357.0034-709410.1016/j.bjan.2018.01.0021806-907Xinfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-10-20T11:00:16Zoai:repositorio.chporto.pt:10400.16/2324Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:38:32.337676Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv [CR-POSSUM and Surgical Apgar Score as predictive factors for patients' allocation after colorectal surgery]
Escore CR‐POSSUM e Índice de Apgar Cirúrgico como fatores preditivos para a alocação de pacientes após cirurgia colorretal
title [CR-POSSUM and Surgical Apgar Score as predictive factors for patients' allocation after colorectal surgery]
spellingShingle [CR-POSSUM and Surgical Apgar Score as predictive factors for patients' allocation after colorectal surgery]
Pinho, S.
CR‐POSSUM
Apgar
Triagem pós‐operatória
Terapia intensiva
Postoperative triage
Intensive care
title_short [CR-POSSUM and Surgical Apgar Score as predictive factors for patients' allocation after colorectal surgery]
title_full [CR-POSSUM and Surgical Apgar Score as predictive factors for patients' allocation after colorectal surgery]
title_fullStr [CR-POSSUM and Surgical Apgar Score as predictive factors for patients' allocation after colorectal surgery]
title_full_unstemmed [CR-POSSUM and Surgical Apgar Score as predictive factors for patients' allocation after colorectal surgery]
title_sort [CR-POSSUM and Surgical Apgar Score as predictive factors for patients' allocation after colorectal surgery]
author Pinho, S.
author_facet Pinho, S.
Lagarto, F.
Gomes, B.
Costa, L.
Nunes, C.
Oliveira, C.
author_role author
author2 Lagarto, F.
Gomes, B.
Costa, L.
Nunes, C.
Oliveira, C.
author2_role author
author
author
author
author
dc.contributor.none.fl_str_mv Repositório Científico do Centro Hospitalar Universitário de Santo António
dc.contributor.author.fl_str_mv Pinho, S.
Lagarto, F.
Gomes, B.
Costa, L.
Nunes, C.
Oliveira, C.
dc.subject.por.fl_str_mv CR‐POSSUM
Apgar
Triagem pós‐operatória
Terapia intensiva
Postoperative triage
Intensive care
topic CR‐POSSUM
Apgar
Triagem pós‐operatória
Terapia intensiva
Postoperative triage
Intensive care
description Background and objectives: Surgical patients frequently require admission in high-dependency units or intensive care units. Resources are scarce and there are no universally accepted admission criteria, so patients' allocation must be optimized. The purpose of this study was to investigate the relationship between postoperative destination of patients submitted to colorectal surgery and the scores ColoRectal Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (CR-POSSUM) and Surgical Apgar Score (SAS) and, secondarily find cut-offs to aid this allocation. Methods: A cross-sectional prospective observational study, including all adult patients undergoing colorectal surgery during a 2 years period. Data collected from the electronic clinical process and anesthesia records. Results: A total of 358 patients were included. Median score for SAS was 8 and CR-POSSUM had a median mortality probability of 4.5%. Immediate admission on high-dependency units/intensive care units occurred in 51 patients and late admission in 18. Scores from ward and high-dependency units/intensive care units patients were statistically different (SAS: 8 vs. 7, p<0.001; CR-POSSUM: 4.4% vs. 15.9%, p<0.001). Both scores were found to be predictors of immediate postoperative destination (p<0.001). Concerning immediate high-dependency units/intensive care units admission, CR-POSSUM showed a strong association (AUC 0.78, p=0.034) with a ≥9.16 cut-off point (sensitivity: 62.5%; specificity: 75.2%), outperforming SAS (AUC 0.67, p=0.048), with a ≤7 cut-off point (sensitivity: 67.3%; specificity: 56.1%). Conclusions: Both CR-POSSUM and SAS were associated with the clinical decision to admit a patient to the high-dependency units/intensive care units immediately after surgery. CR-POSSUM alone showed a better discriminative capacity.
publishDate 2018
dc.date.none.fl_str_mv 2018
2018-01-01T00:00:00Z
2020-03-17T18:53:19Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10400.16/2324
url http://hdl.handle.net/10400.16/2324
dc.language.iso.fl_str_mv por
language por
dc.relation.none.fl_str_mv Pinho S, Lagarto F, Gomes B, Costa L, Nunes CS, Oliveira C. Escore CR‐POSSUM e Índice de Apgar Cirúrgico como fatores preditivos para a alocação de pacientes após cirurgia colorretal [CR-POSSUM and Surgical Apgar Score as predictive factors for patients' allocation after colorectal surgery]. Rev Bras Anestesiol. 2018;68(4):351–357.
0034-7094
10.1016/j.bjan.2018.01.002
1806-907X
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
institution RCAAP
reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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