Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2018.01.006
Brazilian Journal of Anesthesiology
Scientific Article

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

Sílvia Pinho; Filipa Lagarto; Blandina Gomes; Liliana Costa; Catarina S. Nunes; Carla Oliveira

http://dx.doi.org/10.1016/j.bjane.2018.01.006 Braz J Anesthesiol, vol.68, n4, p.351-357, 2018
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Abstract

Abstract 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.

Keywords

CR-POSSUM, Apgar, Postoperative triage, Intensive care

Resumo

Resumo 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.

Palavras-chave

CR-POSSUM, Apgar, Triagem pós-operatória, Terapia intensiva

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