Predicting postoperative complications in pediatric surgery: A novel pediatric comorbidity index.
Predicting postoperative complications in pediatric surgery: A novel pediatric comorbidity index.
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DOI：
10.1016/j.jpurol.2022.03.007
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发表时间：
2022-06
影响因子：
2
通讯作者：
Routh, Jonathan C.
中科院分区：
文献类型：
--
作者：
Tejwani, Rohit;Lee, Hui-Jie;Hughes, Taylor L.;Hobbs, Kevin T.;Aksenov, Leonid, I;Scales, Charles D.;Routh, Jonathan C.
关键词：
合并症驱动的手术风险评估是必要的知情患者咨询，风险分层，和结果为基础的卫生服务研究。现有的以死亡率为中心的合并症指数在儿童风险调整方面取得了好坏参半的成功。开发一种新的合并症驱动的多专业手术风险指数，预测儿童术后30天并发症。这项回顾性队列研究使用MarketScan® Research数据库调查了2014-2015年7个专业接受外科手术的儿童。采用Logistic回归和后向选择分别推导出门诊和住院手术患者的风险指数。使用自举法和受试者工作特征曲线下面积（AUC）比较了新指数与三种现有合并症指数在区分术后并发症方面的性能。我们确定了190，629名门诊患者和22，633名住院患者。新指数对住院患者术后并发症的识别效果最好（AUC 0.76，95%置信区间[CI] 0.75-0.77）相对于Charlson合并症指数（CCI，0.56，95% CI 0.56-0.57）、货车Walraven指数（VWI，0.60，95% CI 0.60-0.61）和Rhee评分（RS，0.69，95% CI 0.68-0.70）（图2）。在非卧床队列中，新指数优于所有三个现有指数，尽管没有一个表现出对并发症的出色区分能力（新评分0.68，95% CI 0.67-0.68; CCI 0.53，95% CI 0.52 -0.53; VWI 0.53，95% CI 0.52-0.53; RS 0.50，95% CI 0.49-0.50）。在住院和门诊儿科环境中，我们的新合并症指数在预测术后并发症方面表现出比三种广泛使用的替代方法更好的性能。该指数将是有用的研究，并可能适用于临床环境，以确定高风险的患者，并促进围手术期计划。我们开发了一种新的儿科合并症指数，在预测术后并发症方面比三种广泛使用的替代方法性能更好。
Comorbidity-driven surgical risk assessment is essential for informed patient counseling, risk-stratification, and outcomes-based health-services research. Existing mortality-focused comorbidity indices have had mixed success at risk-adjustment in children. To develop a new comorbidity-driven multispecialty surgical risk index predicting 30-day postoperative complications in children. This retrospective cohort study investigated children undergoing surgical procedures across seven specialties in 2014–2015 using the MarketScan® Research databases. The risk index was derived separately for ambulatory and inpatient surgery patients using logistic regression with backward selection. The performance of the novel index in discriminating postoperative complications vis-à-vis three existing comorbidity indices was compared using bootstrapping and area under the receiver operating characteristics curves (AUC). We identified 190,629 ambulatory and 22,633 inpatient patients. The novel index had the best performance for discriminating postoperative complications for inpatients (AUC 0.76, 95% confidence interval [CI] 0.75–0.77) relative to the Charlson Comorbidity Index (CCI, 0.56, 95% CI 0.56–0.57), Van Walraven Index (VWI, 0.60, 95% CI 0.60–0.61), and Rhee Score (RS, 0.69, 95% CI 0.68–0.70) (Figure 2). In the ambulatory cohort, the novel index outperformed all three existing indices, though none demonstrated excellent discriminatory ability for complications (novel score 0.68, 95% CI 0.67–0.68; CCI 0.53, 95% CI 0.52–0.53; VWI 0.53, 95% CI 0.52–0.53; RS 0.50, 95% CI 0.49–0.50). In both inpatient and ambulatory pediatric settings, our novel comorbidity index demonstrated better performance at predicting postoperative complications than three widely used alternatives. This index will be useful for research and may be adaptable to clinical settings to identify high-risk patients and facilitate perioperative planning. We developed a novel pediatric comorbidity index with better performance at predicting postoperative complications than three widely used alternatives.
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