Preoperative risk stratification of critically ill patients

Copeland, Curtis C.; Young, Anthony P.; Grogan, Tristan; Gabel, Eilon; Dhillon, Anahat; Gudzenko, Vadim

doi:10.1016/j.jclinane.2017.03.044

Cited by 9 publications

(4 citation statements)

References 22 publications

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“…Candidemia frequently occurs in the context of serious comorbidities, including polymicrobial infection, cardiopulmonary instability, and immunocompromised status, adding to the risks of general anesthesia, if desired for surgery. Although vitrectomy may be performed under local anesthesia with monitored sedation, general anesthesia may be necessary in some cases because of an imminent risk of hemodynamic instability and other considerations; this high risk of complications of anesthesia in these vulnerable patients may then deter surgery altogether . Other risks include retinal detachment, iatrogenic infection, intraocular hemorrhage, cataract, glaucoma, and even death .…”

Section: Discussionmentioning

confidence: 99%

Utility of Ophthalmologic Screening for Patients With Candida Bloodstream Infections

et al. 2019

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Section: Discussionmentioning

confidence: 99%

Utility of Ophthalmologic Screening for Patients With Candida Bloodstream Infections

et al. 2019

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“…[29] Meanwhile, the correlation between postoperative infection and prolonged surgical time is well known because prolonged surgical time increases microbial exposure, and causes peripheral tissue ischemia due to prolonged microvascular retraction, meanwhile, the effect of prophylactic antibiotics is also reduced due to prolonged surgical time. [24] The operative time is jointly determined by many factors and is partially modifiable, including the extent of tumor invasion, vascular variation, abdominal adhesion, etc. These factors increase the difficulty of the operation and prolong the operative time.…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative ASA score is associated with patients' general health and has become an important indicator to judge whether the patient would tolerate surgery or develop various perioperative complications (such as intraoperative bleeding, postoperative ventilator duration, intensive care unit stay length, and mortality, etc). [24] Since intraoperative risk and postoperative complications are a macro concept, it combines many complicated factors. [25] Though the ASA score is often difficult to change as an indicator of patients' risk factors, it is possible to improve patients' preoperative status with appropriate measures to make them safer to tolerate anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Perioperative risk factors for delayed gastric emptying after pancreaticoduodenectomy: a meta-analysis of the complications

Deng

Niu

Han

et al. 2023

Journal of Pancreatology

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To evaluate the correlation between the incidence of delayed gastric emptying (DGE) in pancreaticoduodenectomy (PD) and the perioperative possible risk factors. Methods: We searched PubMed, Embase, Cochrane Library, and Medline for studies describing complications related to PD from 2018 to 2022. Statistical analysis was performed using Stata/SE16.0 software. Results: In 6 retrospective studies, 1 systematic review, and 1 randomized controlled trial (RCT) experiment, 12,419 patients (2174 and 10,245 patients, respectively, in DGE and no delayed gastric emptying [NDGE] groups). The preoperative American Society of Anesthesiologists (ASA) score between DGE and NDGE groups (log odds ratio [OR] = 0.23, 95% credible interval [CI]: 0.11-0.35, P < .01), operation time (mean diff. = 21.87, 95% CI: 15.96-27.78, P < .01), estimated intraoperative blood loss (EIBL; mean diff. = 70.67, 95% CI: 17.75-123.58, P < .05), postoperative pancreatic fistula (POPF) (log OR = 0.85, 95% CI: 0.24-1.46, P < .05) were statistically significant. No significant differences in preoperative body mass index (BMI), preoperative biliary drainage, and pancreatic texture were observed (P > .05). Conclusion:The incidence of DGE is significantly correlated with the operation time, preoperative ASA score, POPF, and EIBL, which suggests that the surgeon should thoroughly evaluate the patient through adequate preoperative examination before the operation. Finally, standardized practice and perfect technology are undoubtedly necessary to reduce complications.

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“…After emergency surgery, P-POSSUM mortality score was a reliable predictor of mortality in elderly patients [ 21 ]. Furthermore ASA physical status has been described as a poor predictor in elderly undergoing emergency surgery where APACHE scores show moderate to good discriminating value [ 7 , 22 ]. Based on these previous published data and the results from this study, it can be concluded that perioperative risk assessment based on parameters obtained at the outpatient clinic is not valid in elderly with septic complications after elective surgery in need of an ICU admission with or without repeated surgery.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Risk Assessment: A Poor Predictor of Outcome in Critically ill Elderly with Sepsis After Abdominal Surgery

et al. 2020

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Background Postoperative outcome prediction in elderly is based on preoperative physical status but its predictive value is uncertain. The goal was to evaluate the value of risk assessment performed perioperatively in predicting outcome in case of admission to an intensive care unit (ICU). Methods A total of 108 postsurgical patients were retrospectively selected from a prospectively recorded database of 144 elderly septic patients (>70 years) admitted to the ICU department after elective or emergency abdominal surgery between 2012 and 2017. Perioperative risk assessment scores including Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality (P-POSSUM) and American Society of Anaesthesiologists Physical Status classification (ASA) were determined. Acute Physiology and Chronic Health Evaluation IV (APACHE IV) was obtained at ICU admission. Results In-hospital mortality was 48.9% in elderly requiring ICU admission after elective surgery (n = 45), compared to 49.2% after emergency surgery (n = 63). APACHE IV significantly predicted in-hospital mortality after complicated elective surgery [area under the curve 0.935 (p < 0.001)] where outpatient ASA physical status and P-POSSUM did not. In contrast, P-POSSUM and APACHE IV significantly predicted in-hospital mortality when based on current physical state in elderly requiring emergency surgery (AUC 0.769 (p = 0.002) and 0.736 (p = 0.006), respectively). Conclusions Perioperative risk assessment reflecting premorbid physical status of elderly loses its value when complications occur requiring unplanned ICU admission. Risks in elderly should be re-assessed based on current clinical condition prior to ICU admission, because outcome prediction is more reliable then.

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Preoperative risk stratification of critically ill patients

Cited by 9 publications

References 22 publications

Utility of Ophthalmologic Screening for Patients With Candida Bloodstream Infections

Utility of Ophthalmologic Screening for Patients With Candida Bloodstream Infections

Perioperative risk factors for delayed gastric emptying after pancreaticoduodenectomy: a meta-analysis of the complications

Preoperative Risk Assessment: A Poor Predictor of Outcome in Critically ill Elderly with Sepsis After Abdominal Surgery

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