Apache-II superiority for the prognosis of mortality after urgent abdominal surgery: multicentric study
Keywords:
mortality prognosis, APACHE, pressure, abdominal cavity, emergency treatment, general surgery.Abstract
Introduction: The mortality prognosis of patients after abdominal surgery demands effective and reproducible aid systems.Objective: To compare the efficacy of three procedures in predicting mortality in emergency laparotomy patients.
Methods: Prospective cohort observational multicenter study with 200 patients in the postoperative period of urgent major abdominal surgery assisted at the "Miguel Enríquez", "Carlos J Finlay", "Hermanos Ameijeiras" hospitals between November 2016 and November 2018. Mean, standard deviation median and interquartile range measures were applied for the comparison between living and deceased and the probability of dying was calculated according to the model that includes both procedures. Discrimination capacity was evaluated by constructing three curves of receiver operational characteristics, areas under the curves and confidence intervals were determined.
Results: Total mortality was 38 % and significantly prevailed in older patients, with a greater number of complications, reoperated patients, and those with septic findings during reoperation. Predictive power was higher for APACHE II compared to the other two procedures (area under the curve 0.912, CI 95%: 0.840-0.933, p< 0.001).
Conclusions: APACHE II is an effective and reliable model for predicting mortality in patients in the postoperative period of major emergency surgery, which makes it highly recommended for this purpose.
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References
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28. Rogers WK, Garcia L. Intraabdominal hypertension, abdominal compartment syndrome, and the open abdomen. Chest. 2018 [acceso: 21/10/2021]; 153(1): [aprox 12 p.]. DOI: 10.1016/j.chest.2017.07.023.
29. Reintam A, Regli A, De Keulenaer B, Kimball EJ, Starkopf L, Davis WA, et al. Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients-A Prospective Multicenter Study (IROI Study). Critical Care Medicine. 2019 [acceso: 21/10/2021]; 47(4): [aprox 7p.]. DOI: 10.1097/ccm.0000000000003623
2. Nag DS. Assessing the risk: Scoring systems for outcome prediction in emergency laparotomies. Biomedicine (Taipei). 2015 [acceso: 21/10/2021]; 5(4): [aprox 1p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4662940
3. Suárez R, Mirabal N, Navarro Z, Planas M, Carbonell R. Factores pronósticos de mortalidad por peritonitis secundaria en pacientes ingresados en una unidad de cuidados intensivos. MEDISAN. 2016 [acceso: 21/10/2021]; 20(10): [aprox 7p.]. Disponible en: https://www.redalyc.org/articulo.oa?id=368447678008
4. Michaels AD, Mullen MG, Guidry CA, Krebs ED, Turrentine FE, Hedrick TL, et al. Unplanned reoperation following colorectal surgery: indications and operations. J Gastrointest Surg. 2017; 21(9): [aprox 5p.]. DOI: 10.1007/s11605-017-3447-5
5. Sartelli M, Catena F, Di Saverio S, Ansaloni L, Malangoni M, Moore EE, et al. Current concept of abdominal sepsis: WSES position paper. World J Emerg Surg. 2014; 9(1): [aprox 1 p.]. DOI: 10.1186/1749-7922-9-22
6. Schorr C, Towsend SR. Chapter 67. Performance Improvement and Severity Scores En: Parrillo J, Dellinger P, editores. Critical Care Medicine: Principles of diagnosis and management in the adults, Section 8: Administrative, Ethical, and Psychological Issues in the Care of the Critically Ill .5thed. Elsevier; 2018. p. 1127-37. Disponible en: https://www.elsevier.com/books/critical-care-medicine/parrillo/978-0-323-44676-1
7. Bouveresse S, Piton G, Badet N, Besch G, Pili-Floury S, Delabrousse E. Abdominal compartment syndrome and intra-abdominal hypertension in critically ill patients: diagnostic value of computed tomography. Eur Radiol. 2019; 29(7): [aprox 7p.]. DOI: 10.1007/s00330-018-5994-x
8. Vincent JL, Ferreira F, Moreno R. Scoring systems for assessing organ dysfunction and survival. Crit Care Clin. 2000; 16(2): [aprox 13p]. DOI: 10.1016/s0749-0704(05)70114-7
9. Knaus WA, Zimmerman JC, Wagner DP, Draper EA, Lawrence DE. APACHE acute physiology and chronic health evaluation a physiologically based classification system. Crit Care Med.1981; 9: [aprox 6p.]. DOI: 10.1097/00003246-198108000-00008
10. Knaus WA, Draper EA, Wagner DP. APACHE II: a severity of disease classification system. Critical Care Medicine. 1985 [acceso: 21/10/2021]; 13: [aprox 11p.]. Disponible en: http://europepmc.org/article/MED/3928249
11. van Ruler O, Kiewiet JJ, Boer KR, Lamme B, Gouma DJ, Boermeester MA, et al. Failure of available scoring systems to predict ongoing infection in patients with abdominal sepsis after their initial emergency laparotomy. BMC Surgery. 2011;11: [aprox 1p.]. DOI: 10.1186/1471-2482-11-38
12. Soler C, Lombardo TA, Tamargo TO, Malbrain ML. Predicting abdominal surgery mortality: a model based on intra-abdominal pressure. MEDICC Review. 2017 [acceso: 21/10/2021]; 19(4): [aprox 4p.]. Disponible en: https://doi.org/10.1590/MEDICC.2017.19040006
13. Smit M, Koopman B, Dieperink W, Hulscher JBF, Hofker HS, van Meurs M, et al. Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU. Annals of intensive care. 2020; 10(1): [aprox 1p.]. DOI: 10.1186/s13613-020-00746-9
14. De Waele JJ, Malbrain MLNG, Kirkpatrick AW. The abdominal compartment syndrome: evolving concepts and future directions. Crit Care. 2015 [acceso: 21/10/2021]; 19: [aprox 1p.]. DOI: 10.1186/s13054-015-0879-8
15. Soler C, Lombardo TA, Tamargo TO, Wise R, Malbrain MLNG. Re-operative abdominal predictive score: a prognostic model combining Acute Re-intervention Predictive Index and intra-abdominal pressure. Anaesthesiol Intensive Ther. 2017 [acceso: 21/10/2021]; 49(5): [aprox 4 p.]. DOI: 10.5603/AIT.a2017.0069
16. Soler C, Lombardo TA, Tamargo TO, Malbrain MNLG. Modelo de pronóstico de reoperación en cirugía abdominal. ARS MEDICA Revista de Ciencias Médicas. 2016 [acceso: 21/10/2021]; 41(3):[aprox 7p.]. Disponible en: https://173.236.243.65/index.php/MED/article/view/56
17. Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Medicine. 2013; 39: [aprox 16 p.]. DOI 10.1007/s00134-013-2906-z
18. World Medical Association Declaration of GINEBRA. Ethical Principles for Medical Research Involving Human Subject. 68th WMA General Assembly, Seoul, October. 2017 [acceso: 21/10/2021]; Disponible en: https://www.wma.net/es/policies-post/declaracion-de-ginebra/
19. World Medical Association Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subject. Seoul: 64th WMA General Assembly; 2013. [acceso: 21/10/2021]. Disponible en: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/
20. González Aguilera JC. Índices y factores pronóstico en pacientes con peritonitis difusas secundarias. [Tesis Doctoral]. Bayamo, Granma: Universidad de Granma; 2004. [acceso: 21/10/2021]; Disponible en: http://tesis.sld.cu/index.php?P=DownloadFile&Id=231
21. Cervantes Betancourt JR. Nuevo índice predictivo para relaparotomías. [Tesis Doctoral]. Villa Clara: UCMVCL; 2012. [acceso: 21/10/2021]. Disponible en: http://eduniv.reduniv.edu.cu/index.php?page=13&id=1115&db=1
22. Lombardo Vaillant TA. Combinación de factores pronósticos para la reintervención y la mortalidad en pacientes de cirugía abdominal. [Tesis Doctoral]. La Habana: UCIMED-FAR, Hospital Militar Central "Dr. Luis Díaz Soto"; 2012.
23. Peña AE, Chang A. Capítulo 3. Sistemas de valoración pronóstica en Medicina Intensiva. En: Caballero A, editor. Terapia Intensiva I. 3ra Ed. La Habana: ECIMED; 2020. p 51-122.
24. Acuña Collazos JA, Domínguez AH, Toro Ocampo EM. Una comparación entre métodos estadísticos clásicos y técnicas metaheurísticas en el modelamiento estadístico. Scientia et Technica. 2012 [acceso: 21/10/2021]; XVII(50):68-77. Disponible en: https://www.redalyc.org/pdf/849/84923878011.pdf
25. Pons JMV, Argimón JM. De la parsimonia en medicina. Med Clin. 2013 [acceso: 21/10/2021]; 141(9): 387-89. Disponible en: http://www.elsevier.es/es-revista-medicina-clinica-2-articulo-de-parsimonia-medicina-S002577531300359X
26. De Laet IE, Malbrain MLNG, De Waele JJ. A Clinician's Guide to Management of Intraabdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients. Crit Care. 2020 [acceso: 21/10/2021]; 24: [aprox 1 p.]. Disponible en: https://doi.org/10.1186/s13054-020-2782-1
27. Milanesi R, Aquino RC. Intra-abdominal pressure: an integrative review. Einstein (Sao Paulo). 2016 [acceso: 21/10/2021]; 14(3): [aprox 7p.]. DOI: 10.1590/S1679-45082016RW3088
28. Rogers WK, Garcia L. Intraabdominal hypertension, abdominal compartment syndrome, and the open abdomen. Chest. 2018 [acceso: 21/10/2021]; 153(1): [aprox 12 p.]. DOI: 10.1016/j.chest.2017.07.023.
29. Reintam A, Regli A, De Keulenaer B, Kimball EJ, Starkopf L, Davis WA, et al. Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients-A Prospective Multicenter Study (IROI Study). Critical Care Medicine. 2019 [acceso: 21/10/2021]; 47(4): [aprox 7p.]. DOI: 10.1097/ccm.0000000000003623
Published
2022-03-14
How to Cite
1.
Soler Morejón C de D, Tamargo Barbeito TO, Lombardo Vaillant TA, Mezquia de Pedro N, Illodo Hernández OL. Apache-II superiority for the prognosis of mortality after urgent abdominal surgery: multicentric study. Rev Cubana Med Milit [Internet]. 2022 Mar. 14 [cited 2025 May 9];51(1):e02201739. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/1739
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