Model for predicting morbidity and mortality and indication for postoperative ICU in patients following oncologic surgery

• Grant number: 10/16360-8
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: December 01, 2010
• End date: November 30, 2012
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Joaquim Edson Vieira
• Grantee: Tatiana Barboza Kronemberger
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

Models to predict surgical outcome are scarce in medical literature. Specifically considering oncologic surgical patients, one specific score was not yet validated. Also is it important to consider the specific conditions of oncologic patients, immunological defenses compromise, nutritional disorders and several coo morbidities. Certainly, oncologic population scheduled to surgery presents more risk when compared to general surgical population. The preoperative clinical stratification of risk aims to identify potential factors that could have negative impact in post operative outcome. However most of the time these evaluation of preoperative risk are subjective, without including intraoperative events, even to indicate ICU reservations facilities for immediate post operative period. Objectives: The principal objective of this study is to identify the preoperative demographic factors, clinical and laboratorial records associated to surgical and anesthetic procedures that could predict with more specificity the immediate and late (30 days) post operative outcome. In a future study, if our present hypothesis was demonstrate, we aimed to introduce based on the score, prophylactic measures to interfere favorably in morbidity and mortality. For that in this study our objective is to compare the pre and intra operative records of patients scheduled to elective oncologic surgery, the records will obtained by means of POSSUM score (Physiological and Operative Severity Score for the enumeration of mortality and morbidity), with postoperative outcomes, including morbidity and mortality, immediate and later (30 days), length of hospital stay, and necessity of Immediate ICU support. It is important to emphasize the rarity of studies employing POSSUM score in oncologic surgery. As secondary objective the patients referred to ICU will be analyzed trying to identify the main factors linked to POSSUM score that could be the responsible for this indication. If affirmative, our intention is to introduce in our Institution this score for routine, avoiding for instance unnecessary ICUs beds reservation for oncologic surgery. Patients and Methods: After our Ethical Committee approval 462 patients scheduled for oncologic surgical surgery (Institute do Cancer do Estado de São Paulo - Octávio Frias de Oliveira - ICESP) will be followed. Previously their data will be recorded and inserted in POSSUM score that contains pre and intra operative data. Also, data from ASA (American Society of Anesthesiologists) will be obtained as a golden pattern, as well as postoperative morbidity and mortality, and ICU requirements and length of stay. At the 30th postoperative day, patients enrolled in the study or their relatives will be interviewed by phone concerning quality of life, physical state and even if the patient deceased. The classificatory variable will be analyzed by means of square Q test or exact of Fisher The quantitative variable will analyzed by means of test T of Student or Mann-Whitney, for that a logistic multiple regression test will be used. P values of P<0.005 will be established as significant. This sample (426 patients) was calculated considering a statistical power of 80% with alpha of 5% considering the historical Hospital records of surgical mortality, and ICU prevalence and stay. After the follow up of 213 patients one interim analyses and one scale of ICU post operative necessity will be elaborated to be validated in the second part of the total sample.