Derivation and validation of a preoperative risk model for postoperative mortality (SAMPE model): An approach to care stratification

Stefani, Luciana Paula Cadore; Gutierrez, Cláudia de Souza; Castro, Stela Maris de Jezus; Zimmer, Rafael; Diehl, Felipe Polgati; Meyer, Leonardo Elman; Caumo, Wolnei

doi:10.1371/journal.pone.0187122

Cited by 32 publications

(27 citation statements)

References 31 publications

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“…[1][2][3] During the past decade, several groups have developed risk stratification models to improve prediction of perioperative major event (including death) in adults and enhance perioperative discussion of risk among physicians and the family, as well as improve resource allocation. [4][5][6][7] The development of comparable risk stratification models has been undertaken in the pediatric surgical population as well. 1,8 In a recent study, we developed the Pediatric Risk Assessment score to predict perioperative mortality in neonates, infants, and children undergoing noncardiac surgery.…”

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confidence: 99%

Pediatric Risk Stratification Is Improved by Integrating Both Patient Comorbidities and Intrinsic Surgical Risk

et al. 2019

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Recently developed risk stratification models for perioperative mortality incorporate patient comorbidities as predictors but fail to consider the intrinsic risk of surgical procedures. In this study, the authors used the American College of Surgeons National Surgical Quality Improvement Program Pediatric database to demonstrate the relationship between the intrinsic surgical risk and 30-day mortality and develop and validate an accessible risk stratification model that includes the surgical procedures in addition to the patient comorbidities and physical status. Methods A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program Pediatric database was performed. The incidence of 30-day mortality was the primary outcome. Surgical Current Procedural Terminology codes with at least 25 occurrences were included. Multivariable logistic regression model was used to determine the predictors for mortality including patient comorbidities and intrinsic surgical risk. An internal validation using bootstrap resampling, and an external validation of the model were performed. Results The authors analyzed 367,065 surgical cases encompassing 659 unique Current Procedural Terminology codes with an incidence of overall 30-day mortality of 0.34%. Intrinsic risk of surgical procedures represented by Current Procedural Terminology risk quartiles instead of broad categorization was significantly associated with 30-day mortality (P < 0.001). Predicted risk of 30-day mortality ranges from 0% with no comorbidities to 4.7% when all comorbidities are present among low-risk surgical procedures and from 0.07 to 46.7% among high-risk surgical procedures. Using an external validation cohort of 110,474 observations, the multivariable predictive risk model displayed good calibration and excellent discrimination with area under curve (c-index) equals 0.95 (95% CI, 0.94 to 0.96; P < 0.001). Conclusions Understanding and accurately estimating perioperative risk by accounting for the intrinsic risk of surgical procedures and patient comorbidities will lead to a more comprehensive discussion between patients, families, and providers and could potentially be used to conduct cost analysis and allocate resources.

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confidence: 99%

Pediatric Risk Stratification Is Improved by Integrating Both Patient Comorbidities and Intrinsic Surgical Risk

et al. 2019

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“…In the context of this study, staying in the operating room meant that patient couldn't wake up early from GA and needed proper intensive care which couldn't be acceded for due to lack of ICU infrastructure. Lack of admission or a late admission to ICU have been found as factors of high mortality postoperatively [38,40,63,64]. Proper PACUs and ICUs should be implanted in theses hospital in order to decrease mortality.…”

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confidence: 99%

General Anaesthesia Related Mortality in a Limited Resource Settings Region: A Retrospective Study in Two Teaching Hospitals of Butembo

Pascal

Malisawa²,

Barratt‐Due

et al. 2020

Preprint

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Background: General anaesthesia (GA) in developing countries is still a high-risk practice, especially in Africa, accompanied with high morbidity and mortality. No study has yet been conducted in Butembo to determine the mortality related to GA practice. The main objective of this study was to assess mortality related to GA in Butembo. Methods: This study was a retrospective analytic study of patients who underwent surgery under GA in the 2 main teaching hospitals of Butembo from January 2011 to December 2015. Data were collected from patients file, anaesthesia registries and were analysed with SPSS 26. Results: From a total of 921patients, male and female patients were 539 (58.5%) 382 (41.5%) respectively. A total of 83 (9.0%) patients died. The overall perioperative mortality rate was 90 per 1,000. From the 83 deaths, 38 occurred within 24h representing GA related mortality of 41 per 1,000. There was a global drop in mortality from 2011 to 2015. The risk factors of death were neonate and senior adult age, emergency operation, ASA physical status more than 2 and single deranged vital sign preoperatively. The occurrence of any complication during GA increased the risk of death. Anaesthesia duration more than 120 minutes increased mortality as well as visceral surgeries/laparotomies. Ketamine was the most employed agent. Conclusion: GA related mortality is very high in Butembo. Improved GA services and outcomes can be obtained by training more anaesthesia providers, proper patients monitoring, enhanced the infrastructure, better equipment and drugs procurement.

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“…This classification was based on the study of Glance et al and adapted to the list of procedures provided in the HCPA information system 15 . A detailed description of the present surgical procedure classification is found in a related article about the development of a postoperative mortality risk model (named SAMPE model) 16 .…”

Section: Methodsmentioning

confidence: 99%

Anesthesia preoperative evaluation clinic (APEC) restructuring plan for improving the quality of surgical patient flow

Alboim¹,

Teixeira²,

Soares³

et al. 2018

Clin. Biomed. Res.

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Introduction: Anesthesia preoperative evaluation clinics (APECs) are useful for high-risk surgical patient care, as they improve perioperative outcomes and optimize patient care flow. At Hospital de Clínicas de Porto Alegre, APEC assesses 20% of all patients undergoing surgery, showing the importance of implementing strategies to improve outpatient clinic efficiency by prioritizing high-risk patients. Methods: Using a specific quality management tool for process improvement (PDCA, which stands for Plan/Do/Check/Act), new protocols were developed for patient referral and preoperative evaluation. Clinical staff was trained in the new routines, and an electronic screening system for patient referral was adopted. Data on patient profiles, referring surgical specialties, type of surgery, and waiting times for appointment and surgical procedure were compared before and after the intervention. Results: APEC performed 1,286 appointments between 2013 and 2016, including 733 pre-intervention and 553 post-intervention. There was a significant decrease in the appointments for patients undergoing minor surgery and an increase in the appointments for those undergoing major surgery. The waiting time between referral to APEC and first APEC appointment reduced from 46 to 16 days. In addition, there was an increase in vascular, orthopedic, and urology referrals, as well as a reduction in ophthalmology and general surgery referrals. Conclusions: The PDCA method assisted with conceiving, executing, and monitoring the implemented strategies for changing the profile of patients evaluated at APEC. The major challenge is to measure the long-term impact of this intervention and expand care through specific strategies for surgical specialties and procedures.

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Derivation and validation of a preoperative risk model for postoperative mortality (SAMPE model): An approach to care stratification

Cited by 32 publications

References 31 publications

Pediatric Risk Stratification Is Improved by Integrating Both Patient Comorbidities and Intrinsic Surgical Risk

Pediatric Risk Stratification Is Improved by Integrating Both Patient Comorbidities and Intrinsic Surgical Risk

General Anaesthesia Related Mortality in a Limited Resource Settings Region: A Retrospective Study in Two Teaching Hospitals of Butembo

Anesthesia preoperative evaluation clinic (APEC) restructuring plan for improving the quality of surgical patient flow

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