Ohkura et al developed a score for identifying a patient at risk for complications following laparoscopic gastrectomy. This can help to identify a patient who may benefit from more aggressive management. The authors are from Toranomon Hospital and Kyoto University.
Patient selection: laparoscopic gastrectomy (proximal, distal or total)
Outcome: postoperative complications (pancreatic fistula, pulmonary complications, anastomotic leak or stricture, bleeding, liver damage, surgical site infection, other); time frame not specified
Parameters:
(1) age in years
(2) ASA class
(3) significant pulmonary disease (SPD), defined FEV1 < 50% or vital capacity < 60% of predicted
(4) history of upper abdominal surgery (HUAS)
(5) Brinkman index (number of cigarettes smoked per day times the number of years smoked)
|
Parameter |
Finding |
Points |
|
age in years |
< 75 years |
0 |
|
|
>= 75 years |
0.181 |
|
ASA |
I |
0 |
|
|
II or higher |
0.119 |
|
significant pulmonary disease |
absent |
0 |
|
|
present |
0.286 |
|
history of upper abdominal surgery |
no |
0 |
|
|
yes |
0.442 |
|
Brinkman index |
< 600 |
0 |
|
|
>= 600 |
0.172 |
where:
• Evidence of severe pulmonary disease or heavy smoking makes an ASA of II unlikely.
PR score =
= SUM(points for all 5 parameters) + 0.105
Interpretation:
• minimum score: 0.105
• maximums score: 1.305
• The higher score the greater the risk of postoperative complications
|
PR Score |
Category |
Complication Rate |
|
< 0.20 |
0 |
4% |
|
0.20 to 0.249 |
1 |
11% |
|
0.25 to 0.299 |
2 |
11% |
|
0.30 to 0.399 |
3 |
15% |
|
0.4 to 0.499 |
4 |
30% |
|
0.5 to 0.699 |
5 |
33% |
|
0.7 to 0.999 |
6 |
60% |
|
>= 1.0 |
7 |
66% |
In addition, the complication rate increased with body mass index. At a BMI <= 20 kg per sq meter the complication rate was around 5%, going to 40% for BMI >= 30. In Figure 1 the plot is missing BMIs 26 and 28 along the x-axis.
|
BMI |
Complications |
|
<= 20 |
5% |
|
21 |
15% |
|
22 |
15% |
|
23 |
21% |
|
24 |
27% |
|
25 |
30% |
|
27 |
32% |
|
29 |
34% |
|
>=30 |
40% |
The authors provided contour maps of risk displayed in plots of BMI versus PR score (Figures 4 and 5).
Performance:
• The area under the ROC curve was 0.72.
Specialty: Anesthesiology, Surgery, general
