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429 Preoperative Risk Assessment In Elective Colorectal Patients

C Cernei, R Grossman, Owen Bodger Orcid Logo, J Williams, C Pritchard, A Goede

British Journal of Surgery, Volume: 108, Issue: Supplement_6

Swansea University Author: Owen Bodger Orcid Logo

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DOI (Published version): 10.1093/bjs/znab259.410

Abstract

Abstract Introduction Cardiopulmonary Exercise Testing (CPET) and the Colorectal Physiology and Operative Severity Score (CR-POSSUM) are increasingly used in colorectal surgical practice to risk-stratify patients preoperatively and for planning level 2 HDU or ITU admission. This study aims to genera...

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Published in: British Journal of Surgery
ISSN: 0007-1323 1365-2168
Published: Oxford University Press (OUP) 2021
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URI: https://cronfa.swan.ac.uk/Record/cronfa58486
first_indexed 2021-10-27T16:15:42Z
last_indexed 2021-11-19T04:25:52Z
id cronfa58486
recordtype SURis
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spelling 2021-11-18T16:53:49.2891566 v2 58486 2021-10-27 429 Preoperative Risk Assessment In Elective Colorectal Patients 8096440ab42b60a86e6aba678fe2695a 0000-0002-4022-9964 Owen Bodger Owen Bodger true false 2021-10-27 MEDS Abstract Introduction Cardiopulmonary Exercise Testing (CPET) and the Colorectal Physiology and Operative Severity Score (CR-POSSUM) are increasingly used in colorectal surgical practice to risk-stratify patients preoperatively and for planning level 2 HDU or ITU admission. This study aims to generate a simple, objective pre-operative risk assessment model to complement clinical judgement, and to determine objectively for whom CPET is necessary in colorectal pre-assessment. Method A retrospective cohort study was conducted. Demographic and perioperative data were gathered, and CR-POSSUM score was determined retrospectively. Mortality at 12 months was considered the primary outcome with readmissions up to 12 months as secondary outcomes. Statistical analysis used Binary Logistic Regression, and odds ratios were reported with confidence intervals. A new combined pre-operative risk assessment model with the most significant individual predictors was constructed. Results Some 167 elective patients were included in the final analysis. Half of patients had planned HDU admissions. The all-cause mortality at 90 days was 3.5% and at 12 months was 11%. Readmission rate at 30 days was 10%, with a further 11.3% at 90 days postoperatively. The ASA, Physiology Score and Operative Severity Scores correlated with mortality rates (p &amp;lt; 0.05). Current diagnostic performance using CPET vs. the combined model identified 48% and 35% ‘high risk’ patients with 83.3% and 56.5% vs 94.4% and 76.1% sensitivity and specificity, respectively. The model draws its predictive power mainly from the CR-POSSUM. Conclusions Current practice at the study centre produces outcomes above the national average. The process can be improved whilst focusing resources further using the combined model. Journal Article British Journal of Surgery 108 Supplement_6 Oxford University Press (OUP) 0007-1323 1365-2168 Surgery 12 10 2021 2021-10-12 10.1093/bjs/znab259.410 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University 2021-11-18T16:53:49.2891566 2021-10-27T17:13:49.6720327 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine C Cernei 1 R Grossman 2 Owen Bodger 0000-0002-4022-9964 3 J Williams 4 C Pritchard 5 A Goede 6
title 429 Preoperative Risk Assessment In Elective Colorectal Patients
spellingShingle 429 Preoperative Risk Assessment In Elective Colorectal Patients
Owen Bodger
title_short 429 Preoperative Risk Assessment In Elective Colorectal Patients
title_full 429 Preoperative Risk Assessment In Elective Colorectal Patients
title_fullStr 429 Preoperative Risk Assessment In Elective Colorectal Patients
title_full_unstemmed 429 Preoperative Risk Assessment In Elective Colorectal Patients
title_sort 429 Preoperative Risk Assessment In Elective Colorectal Patients
author_id_str_mv 8096440ab42b60a86e6aba678fe2695a
author_id_fullname_str_mv 8096440ab42b60a86e6aba678fe2695a_***_Owen Bodger
author Owen Bodger
author2 C Cernei
R Grossman
Owen Bodger
J Williams
C Pritchard
A Goede
format Journal article
container_title British Journal of Surgery
container_volume 108
container_issue Supplement_6
publishDate 2021
institution Swansea University
issn 0007-1323
1365-2168
doi_str_mv 10.1093/bjs/znab259.410
publisher Oxford University Press (OUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 0
active_str 0
description Abstract Introduction Cardiopulmonary Exercise Testing (CPET) and the Colorectal Physiology and Operative Severity Score (CR-POSSUM) are increasingly used in colorectal surgical practice to risk-stratify patients preoperatively and for planning level 2 HDU or ITU admission. This study aims to generate a simple, objective pre-operative risk assessment model to complement clinical judgement, and to determine objectively for whom CPET is necessary in colorectal pre-assessment. Method A retrospective cohort study was conducted. Demographic and perioperative data were gathered, and CR-POSSUM score was determined retrospectively. Mortality at 12 months was considered the primary outcome with readmissions up to 12 months as secondary outcomes. Statistical analysis used Binary Logistic Regression, and odds ratios were reported with confidence intervals. A new combined pre-operative risk assessment model with the most significant individual predictors was constructed. Results Some 167 elective patients were included in the final analysis. Half of patients had planned HDU admissions. The all-cause mortality at 90 days was 3.5% and at 12 months was 11%. Readmission rate at 30 days was 10%, with a further 11.3% at 90 days postoperatively. The ASA, Physiology Score and Operative Severity Scores correlated with mortality rates (p &amp;lt; 0.05). Current diagnostic performance using CPET vs. the combined model identified 48% and 35% ‘high risk’ patients with 83.3% and 56.5% vs 94.4% and 76.1% sensitivity and specificity, respectively. The model draws its predictive power mainly from the CR-POSSUM. Conclusions Current practice at the study centre produces outcomes above the national average. The process can be improved whilst focusing resources further using the combined model.
published_date 2021-10-12T05:10:38Z
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score 11.3749895

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