RU-2861534-C1 - METHOD FOR PREOPERATIVE PREDICTION OF RISK OF DEVELOPING SEVERE POSTOPERATIVE COMPLICATIONS IN ELECTIVE ABDOMINAL SURGERY

Abstract

FIELD: medicine. SUBSTANCE: invention relates to abdominal surgery and can be used for preoperative prediction of the risk of developing severe postoperative complications. The type of surgical intervention (laparoscopic or open proctological operation), the duration of voluntary threshold apnoea during a breath-hold test, the presence of alcohol dependence, and the smoking history in years are determined. Based on the obtained data, a prognostic index K is calculated using the presented mathematical formula. If the K value is more than -3.2273, a high risk of developing complications is predicted; if the K value is -3.2273 or less, a low risk is predicted. EFFECT: identification of high-risk patients for timely optimisation of the perioperative period by assessing a set of preoperative factors that significantly influence the occurrence of an adverse outcome in elective surgery. 1 cl, 3 tbl, 2 ex

Inventors

• ZABOLOTSKIKH IGOR BORISOVICH
• KOKHNO VLADIMIR NIKOLAEVICH
• Dunts Pavel Vadimovich
• Malyshev Iurii Pavlovich
• Musaeva Tatiana Sergeevna
• TREMBACH NIKITA VLADIMIROVICH
• Magomedov Marat Adessovich
• Gritsan Aleksei Ivanovich
• Khoronenko Viktoriia Eduardovna
• Ovezov Aleksei Muradovich
• POPOV ALEKSANDR SERGEEVICH
• Fisher Vasilii Vladimirovich

Dates

Publication Date

20260505

Application Date

20250812

Claims (8)

1. A method for preoperative prediction of the risk of developing severe postoperative complications in planned abdominal surgery, including determining the type of surgical intervention, characterized in that before the operation, the duration of voluntary threshold apnea in seconds is additionally determined by conducting a breath-holding test on inspiration (F 1 ), the presence of alcohol dependence (F 2 ), the type of surgical intervention: laparoscopic surgery (F 3 ) and open proctological surgery (F 4 ), smoking history in years (F 5 ) and then the risk of developing severe postoperative complications is determined using the formula:
2. K = (-0.71708) + F 1 × (-0.095552) + F 2 × 2.92671 + F 3 × (-2.21700) + F 4 × 1.08109 + F 5 × 0.039738, where:
3. K is the value of the prognostic index;
4. F 1 - duration of arbitrary threshold apnea in seconds, determined by conducting a breath-holding test on inhalation;
5. F 2 - the presence of alcohol dependence, and in the presence of alcohol dependence F 2 is taken equal to 1, in the absence - 0;
6. F 3 - type of surgical intervention: laparoscopic surgery, where F 3 is taken as 1 if the operation is laparoscopic, and as 0 if it is other types of surgical intervention;
7. F 4 - type of surgical intervention: open proctological surgery, where F 4 is taken as 1 if the surgery is open proctological, and as 0 if it is other types of surgical intervention; F 5 - smoking experience in years;
8. and with a K value of more than -3.2273, a high risk of developing severe postoperative complications is predicted; with a K value of -3.2273 or less, a low risk of developing severe postoperative complications is predicted.

Description

The proposed invention relates to medicine, namely to anesthesiology and resuscitation, and can be used in assessing the risk of developing severe postoperative complications (grade III or higher according to the Clavien-Dindo classification of surgical complications, requiring surgical, endoscopic, radiological interventions) during planned operations on abdominal organs. Current approaches to determining perioperative risk typically focus on the isolated determination of either the risk of death or the risk of specific complications, or, less commonly, critical incidents. Postoperative adverse outcomes, such as infections, cardiovascular diseases, pulmonary complications, acute kidney injury, etc., occur after every fifth surgical intervention (Chaudery H., MacDonald N., Ahmad T. et al. Acute Kidney Injury and Risk of Death After Elective Surgery: Prospective Analysis of Data From an International Cohort Study. Anesth Analg. 2019;128(5):1022-1029). Results of a large multicenter cohort study in the United States revealed a strong association between postoperative complications and decreased survival (Khuri S.F., Henderson W.G., DePalma R.G. et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242(3):326-343). The study authors demonstrate that 7-15% of patients who underwent major surgery developed postoperative complications (Tevis S.E., Cobian A.G., Truong H.P. et al. Implications of Multiple Complications on the Postoperative Recovery of General Surgery Patients. Ann Surg. 2016;263(6):1213-1218; Haynes A.B., Weiser T.G., Berry W.R. et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491-499). In addition, the overall postoperative mortality rate ranged from 0.79 to 5.7% (Tevis SE, Kennedy GD. Postoperative complications and implications on patient-centered outcomes. J Surg Res. 2013;181(1):106–113). The presence of postoperative complications also affected long-term outcomes: two-year mortality was almost three times higher in patients with complicated postoperative periods (Fowler AJ, Brayne AB, Pearse RM et al. Long-term healthcare use after postoperative complications: an analysis of linked primary and secondary care routine data. BJA Open. 2023;7:100142). According to the Clavien-Dindo classification, postoperative complications are defined as any deviation from the normal course of the postoperative period, which means that the severity varies from non-life-threatening complications without long-term disability to fatal outcomes (Straatman J., Cuesta M.A., de Lange-de Klerk E.S. et al. Hospital cost-analysis of complications after major abdominal surgery. Dig Surg. 2015;32(2):150-156; Clavien P.A., Sanabria J.R., Strasberg S.M. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111(5):518-526). Postoperative complications can have a significant impact on the individual patient, potentially reducing both quality of life and functional capacity (Tevis S.E., Cobian A.G., Truong H.P. et al. Implications of Multiple Complications on the Postoperative Recovery of General Surgery Patients. Ann Surg. 2016;263(6):1213-1218). From a societal perspective, they can lead to additional healthcare costs, intensive care unit (ICU) stays, reoperation, or readmission (Healy M.A., Mullard A.J., Campbell D.A. Jr. et al. Hospital and Payer Costs Associated With Surgical Complications. JAMA Surg. 2016;151(9):823-830). Thus, predicting severe postoperative complications in planned abdominal surgery will allow for their timely detection and prevention, which will improve the patient's prognosis. One of the analogues is the SORT (Surgical Outcome Risk Tool) scale - a scale of outcome risk in surgery, represented by the following equation: Score = (ASA III*1.411)+(ASA IV*2.378)+(ASA V*4.081)+(emergency, delayed surgery*1.236)/(emergency, urgent surgery*1.657)/(immediate surgery*2.452)+(high-risk location*0.712)+(increased complexity of surgery*0.381)+(cancer*0.667)+(age 65-79 years*0.777)/(age >79 years*1.591) (Protopapa KL, Simpson JC, Smith NC, Moonesinghe SR. Development and validation of the Surgical Outcome Risk Tool (SORT). British Journal of Surgery. 2014;101(13):1774-1783). Disadvantages of the method: 1. The scale showed high sensitivity only to a number of complications, mainly surgical ones (intestinal paresis). 2. Low sensitivity of predicting complications - 0.738. 3. It is inferior to other scales in the accuracy of predicting cardiac and respiratory complications. The NZRISK (New Zealand RISK) scale is an adaptation of the SORT scale; the score is calculated using the formula: M = (age in years * 0.060) + (urgency of surgery * 2.236) + (ASA III * 0.448) / (ASA IV or ASA V * 0.752) + (severity of surgery 4th or 5th category * 0.593) + (oncology * 0.936) + (surgeries on the gastrointestinal tract * 0.640) /