Stratification of Perioperative Risk in Patients with Acute Abdominal Surgical Pathology

O.V. Kravets, E.N. Kligunenko, V.V. Ekhalov

Abstract


Relevance. The complexity of providing qualitative care to patients with urgent abdominal disorders associa­ted with the heterogeneity of entities that require to evaluate the patient’s condition and perform preoperative preparation under tight time constraints. Objective: a comparative assessment of the sensitivity of the forecast for the development of postope­rative complications and lethality by the scale of surgical risk ASA and POSSUM in patients with acute surgical pathology of abdominal organs. Materials and methods. The study involved 130 patients operated urgently for acute abdominal pathology. The stratification of surgical risk was performed using rating scales ASA and POSSUM. Postoperative complications were evaluated according to the classification of Clavien — Dindo. Control points: before operation, 28–30 hours after surgery. Results. According to a pre-perioperative surgical risk stratification according to ASA predicted risk of perioperative mortality in patients with acute surgical pathology of abdominal organs before surgery was 21.5 %, which corresponded to the level of class III. Besides calculated risks for perioperative mortality and postoperative complication in these patients by POSSUM amounted to 14.4 and 53.1 %, respectively. The development of postoperative complications was observed in 64 patients that amounted to 49.9 %. Within thirty days of following up of postoperative mortality there were registered 12 cases of in-hospital mortality (13.2 %) at average maturity mortality to 16 days. Conclusions. 1. Evaluation of operational and anesthetic risk according to ASA may not accurately determine the risk of occurrence of postoperative mortality, does not consider the risk of postoperative complications. 2. Determination of operational and anesthetic risk by POSSUM significantly coincides with the actual incidence of postoperative complications and mortality.


Keywords


stratification of surgical risk; urgent surgery; postoperative complications; postoperative mortality

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DOI: https://doi.org/10.22141/2224-0586.6.77.2016.82172

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