Simoes et al identified risk factors for major complications or death within 30 days of elective abdominal surgery in a patient with cancer. These can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in Brazil, Belgium and Italy.
Patient selection: elective abdominal surgery in a cancer patient
Outcome: major (infectious, cardiovascular, respiratory, neurologic, renal and surgical) complications or death within 30 days
Risk factors:
(1) older age
(2) ASA class >= 3 (Class 4 or 5 unlikely to be elective)
(3) preoperative hemoglobin < 12 g/dL
(4) intraoperative infusion of colloids (6% hydroxyethyl starch, HES)
(5) greater volume of intravenous fluids infused
(6) intraoperative blood loss > 500 mL
(7) hypotension requiring vasopressor therapy
where:
• The age for patients with complications was 63.3 +/- 12.5 versus 57.8 +/- 14.5 so there is considerable overlap. Older age will be >= 65 years in the implementation.
• The volume of IV fluids for patients with complications was 5 liters versus 3 liters. A volume >= 5 liters will be used in the implementation to indicate risk.
The more the number of risk factors present the greater the risk of complications.
