Severe morbidity after pancreatectomy is accurately predicted by preoperative pancreatic resection score (PREPARE): A prospective validation analysis from a medium-volume center

López, M. Rodríguez; Tejero-Pintor, Francisco J.; Pérez-Saborido, B.; Barrera-Rebollo, A.; Bailon-Cuadrado, M.; Pacheco-Sánchez, D.

doi:10.1016/j.hbpd.2018.09.017

Cited by 3 publications

(6 citation statements)

References 41 publications

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“…Частота тяжелых послеоперационных осложнений (≥III сте пени по Clavien-Dindo) составляет порядка 70% от всех осложнений и 30% от всех пациентов, что приводит к увеличению продолжительности госпитализации, частоты повторных госпитализаций и финансовых затрат [16,17]. Это подтверждает актуальность прогнозирования и ранней диагностики осложнений [6,[12][13][14].…”

Section: Discussionunclassified

“…В представленном исследовании частота тяжелых осложнений составила 32%, что сопоста-вимо с результатами других исследований [6,12,14]. Однако распределение категорий риска и их соотношение с числом тяжелых осложнений не похожи на данные, представленные другими авторами [6,[12][13][14]. В этих исследованиях также была продемонстрирована значимая прогностическая способность шкалы PREPARE.…”

Section: Discussionunclassified

“…Стоит заметить, что в испанском исследовании был большой риск случайной ошибки (ложноположительный результат) ввиду небольшого размера выборки (5 пациентов с серьезными осложнениями). В 2018 г. те же авторы продемонстрировали результаты применения PREPARE у 50 больных [14]. Эти данные сопоставимы с предыдущими исследованиями (AUC = 0,712; 95% ДИ 0,555-0,869; тест Hosmer-Lemeshow p = 0,86).…”

Section: вве де ниеunclassified

“…После подсчета баллов (табл. 1) пациентов стратифицировали по риску: малый риск -менее 6 баллов, средний риск -6-9 баллов, большой риск -более 9 баллов [14].…”

Section: материал и методыunclassified

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Prediction of severe postoperative complications in pancreatic surgery using the Preoperative Pancreatic Resection (PREPARE) score: a single-center observational study

et al. 2022

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Aim. To evaluate the effectiveness of the PREPARE score in predicting severe complications after pancreatic surgery.Materials and Methods. The case-control study included patients operated on the pancreas. Grade ≥III Clavien– Dindo complications were designated as “severe”. Patients were divided into two groups: “0–II degree” (control) and “III–V degree” (case). For all patients, scores were calculated, and risk categories were determined according to the PREPARE score.Results. The study included 151 patients: “0–II degree” – 102 (68%) observations, “III–V degree” – 49 (32%). ROC analysis was used for the scores (AUC = 0.616; 95% CI 0.527–0.706; p = 0.014) and for the risk categories (AUC = 0.555; 95% CI 0.463–0.648; p = 0.241) of the PREPARE score.Conclusion. The obtained data do not currently enable us to recommend the PREPARE score for predicting complications of pancreatic surgery.

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Section: материал и методыunclassified

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Prediction of severe postoperative complications in pancreatic surgery using the Preoperative Pancreatic Resection (PREPARE) score: a single-center observational study

et al. 2022

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“…Clavien–Dindo of II or higher was considered significant, whereas most studies reported in the literature use alternative cut-offs (IIIa, IIIb, or higher) [ 2 , 4 , 8 , 23 , 28 ]. The PREPARE calculator was developed by Uzunoglu F et al and validated in Rodriguez-Lopez M et al series [ 41 , 42 ]. It demonstrated a moderate accuracy with an AUC of 0.71 (95% CI: 0.56–0.87) and Hosmer–Lemeshow, p = 0.86, yet the validation cohort incorporated a small number of patients ( n = 50), there were patients who underwent distal pancreatectomy, and it was not mentioned how many patients had this type of resection.…”

Section: Discussionmentioning

confidence: 99%

External Validation of a Risk Model for Severe Complications following Pancreatoduodenectomy Based on Three Preoperative Variables

Alhulaili

Pleijhuis

Nijkamp

et al. 2022

Cancers

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Background: Pancreatoduodenectomy (PD) is the only cure for periampullary and pancreatic cancer. It has morbidity rates of 40–60%, with severe complications in 30%. Prediction models to predict complications are crucial. A risk model for severe complications was developed by Schroder et al. based on BMI, ASA classification and Hounsfield Units of the pancreatic body on the preoperative CT scan. These variables were independent predictors for severe complications upon internal validation. Our aim was to externally validate this model using an independent cohort of patients. Methods: A retrospective analysis was performed on 318 patients who underwent PD at our institution from 2013 to 2021. The outcome of interest was severe complications Clavien–Dindo ≥ IIIa. Model calibration, discrimination and performance were assessed. Results: A total of 308 patients were included. Patients with incomplete data were excluded. A total of 89 (28.9%) patients had severe complications. The externally validated model achieved: C-index = 0.67 (95% CI: 0.60–0.73), regression coefficient = 0.37, intercept = 0.13, Brier score = 0.25. Conclusions: The performance ability, discriminative power, and calibration of this model were acceptable. Our risk calculator can help surgeons identify high-risk patients for post-operative complications to improve shared decision-making and tailor perioperative management.

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Preoperative nutritional support in patients undergoing pancreatic surgery affects PREPARE score accuracy

Skalicky,

Knapkova,

Tesarikova

et al. 2023

Front. Surg.

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BackgroundThis study aimed to validate the accuracy of the Preoperative Pancreatic Resection (PREPARE) risk score in pancreatic resection patients.Patients and methodsThis prospective study included 216 patients who underwent pancreatic resection between January 2015 and December 2018. All patients in our cohort with weight loss or lack of appetite received dietary advice and preoperative oral nutritional supplementation (600 kcal/day). Demographic, clinicopathological, operative, and postoperative data were collected prospectively. The PREPARE score and the predicted risk of major complications were computed for each patient. Differences in major postoperative complications were analyzed using a multivariate Cox proportional hazards regression model. The predicted and observed risks of major complications were tested using the C-statistic.ResultsThe study included 216 patients [117 men (54.2%)] with a median age of 65.0 (30.0–83.0) years. The majority of patients were classified as American Society of Anesthesiologists (ASA)’ Physical Status score II (N = 164/216; 75.9%) and as “low risk” PREPARE score (N = 185/216; 85.6%) before the surgery. Only 4 (1.9%) patients were malnourished, with albumin levels of less than 3.5 g/dl. The most common type of pancreatic resection was a pylorus-preserving pancreaticoduodenectomy (N = 122/216; 56.5%). Major morbidity and 30-day mortality rates were 11.1% and 1.9%, respectively. The type of surgical procedure (hazard ratio [HR]: 3.849; 95% confidence interval [CI]: 1.208–12.264) and ASA score (HR: 3.089; 95% CI: 1.067–8.947) were significantly associated with the incidence of major postoperative complications in multivariate analysis. The receiver operating characteristic curve was 0.657 for incremental values and 0.559 for risk categories, indicating a weak predictive model.ConclusionThe results of the present study suggest that the PREPARE risk score has low accuracy in predicting the risk of major complications in patients with consistent preoperative nutritional support. This limits the use of PREPARE risk score in future preoperative clinical routines.

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Severe morbidity after pancreatectomy is accurately predicted by preoperative pancreatic resection score (PREPARE): A prospective validation analysis from a medium-volume center

Cited by 3 publications

References 41 publications

Prediction of severe postoperative complications in pancreatic surgery using the Preoperative Pancreatic Resection (PREPARE) score: a single-center observational study

Prediction of severe postoperative complications in pancreatic surgery using the Preoperative Pancreatic Resection (PREPARE) score: a single-center observational study

External Validation of a Risk Model for Severe Complications following Pancreatoduodenectomy Based on Three Preoperative Variables

Preoperative nutritional support in patients undergoing pancreatic surgery affects PREPARE score accuracy

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