Uzunoglu et al reported the Preoperative Pancreatic Resection (PREPARE) score for preoperative assessment of a patient undergoing pancreatic resection. This can help to identify a high-risk patient who may benefit from more aggressive management. The authors are from University Medical Centre Hamburg-Eppendorf, St. Josef-Hospital Bochum, Hospital of the Ruhr University, University of Milan and University of Verona.
Patient selection: pancreatic resection
Outcome: major complications (Clavien-Dindo classification III to V)
Parameters:
(1) serum albumin concentration in g/dL
(2) surgical acuity
(3) surgical procedure
(4) pathology of pancreatic origin
(5) heart rate in beats per minute
(6) systolic blood pressure in mm Hg
(7) hemoglobin concentration in g/dL
(8) ASA status
|
Parameter
|
Finding
|
Points
|
|
serum albumin
|
>= 3.5 g/dL
|
0
|
|
|
< 3.5 g/dL
|
5
|
|
surgical acuity
|
elective
|
0
|
|
|
urgent or emergency
|
4
|
|
surgical procedure
|
DP, TP, other
|
0
|
|
|
PD, PPPD, DPPHR
|
2
|
|
pancreatic pathology
|
no
|
2
|
|
|
yes
|
0
|
|
heart rate
|
< 50 beats per minute
|
2
|
|
|
50 to 80 beats per minute
|
0
|
|
|
> 80 beats per minute
|
2
|
|
systolic blood pressure
|
< 110 mm Hg
|
2
|
|
|
110 to 130 mm Hg
|
0
|
|
|
> 130 mm Hg
|
2
|
|
hemoglobin
|
< 11.5 g/dL
|
1
|
|
|
11.5 to 17 g/dL
|
0
|
|
|
> 17 g/dL
|
1
|
|
ASA score
|
1 or 2
|
0
|
|
|
>= 3
|
1
|
where:
• DP = distal pancreatectomy
• DPPHR = duodenum-preserving pancreatic head resection
• PD = pancreaticoduodenectomy
• PPPD = pylorus-preserving pancreaticoduodenectomy
• TP = total pancreatectomy
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score 19
• The higher the score the greater the risk of complications.
|
Total Score
|
Percent Major Complications
|
|
0
|
8%
|
|
1
|
11%
|
|
2
|
13%
|
|
3
|
17%
|
|
4
|
22%
|
|
5
|
27%
|
|
6
|
33%
|
|
7
|
44%
|
|
8
|
47%
|
|
9
|
58%
|
|
10
|
65%
|
|
11
|
72%
|
|
12
|
82%
|
|
13
|
86%
|
|
14
|
89%
|
|
15
|
92%
|
|
16-19
|
> 92%
|
Performance:
• The area under the ROC curve was 0.71.
