Optimizing classical risk scores to predict complications in head and neck surgery: a new approach

Abstract

Purpose To validate tools to identify patients at risk for perioperative complications to implement prehabilitation programmes in head and neck surgery (H&N). Methods Retrospective cohort including 128 patients submitted to H&N, with postoperative Intermediate Care Unit admittance. The accuracy of the risk calculators ASA, P-POSSUM, ACS-NSQIP and ARISCAT to predict postoperative complications and mortality was assessed. A multivariable analysis was subsequently performed to create a new risk prediction model for serious postoperative complications in our institution. Results Our 30-day morbidity and mortality were 45.3% and 0.8%, respectively. The ACS-NSQIP failed to predict complications and had an acceptable discrimination ability for predicting death. The discrimination ability of ARISCAT for predicting respiratory complications was acceptable. ASA and P-POSSUM were poor predictors for mortality and morbidity. Our new prediction model included ACS-NSQIP and ARISCAT (area under the curve 0.750, 95% confidence intervals: 0.63-0.87). Conclusion Despite the insufficient value of these risk calculators when analysed individually, we designed a risk tool combining them which better predicts the risk of serious complications.

Concordance between ARISCAT risk score and cardiopulmonary exercise test values in risk prediction of postoperative pulmonary complications of major abdominal surgeries in a tertiary cancer hospital: A cross‐sectional study

“…15 However, it seems that ARISCAT risk score has short comings and conflicting results in patients with certain types of cancer, comorbidities, and underlying lung disease. 16 Cardiopulmonary exercise test (CPET) is commonly used to predict risk in intrathoracic surgeries, especially lung cancer resections. However, its role is not well-defined in non-thoracic surgeries.…”

“…In addition to its simplicity, the risk score is an externally validated model with sufficient prediction power among existing risk scores 15 . However, it seems that ARISCAT risk score has short comings and conflicting results in patients with certain types of cancer, comorbidities, and underlying lung disease 16 . Cardiopulmonary exercise test (CPET) is commonly used to predict risk in intrathoracic surgeries, especially lung cancer resections.…”