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.
