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Pre operative fitness score accurately predicts uneventful post operative course in gastrointestinal and hepatobiliary surgery.

By BHAVIN VASAVADA, hardik patel

Posted 17 Apr 2020
medRxiv DOI: 10.1101/2020.04.14.20057612

Background: Aim of our study was to analyze if we can acuratly predict uneventful post operative course pre operatively in gastrointestinal and HPB surgery patients so that we can better explain risk benefit ratio to the patients and prognostify the results. Material and Methods: We retrospectively evaluated patients who have undergone gastrointestinal and hepatobiliary surgery at our institute in last 3 years and analyzed 90 days mortality and morbidity rates among these patients. We described any 90 day morbidity and mortality as an event. We performed univariate and multivariate analyses for factors predicting an event. Then based on pre operative factors that predicted an event we formulated a score and then evaluated sensitivity, specificity, positive predictive and negative predictive value of that score and also evaluated ROC curve. We also performed kaplan-meier analysis for 90 days event free survival. Statistical analysis was done using SPSS version 23. Results: Total 264 patient operated for gastrointestinal and HPB surgeries between april 2016 to may 2019 were evaluated .Total 45 (17%) events occurred. On univariate analysis CDC grade, ASA score,Operative time,Blood products used, emmergency surgeries and open surgeries predicted an event.We developed score based on pre operative factors like ASA score, CDC grade of surgery,open surgery and emmergency surgeries included in the score. Each variable was given 1 point.We proposed score grater than 2 was associated with 90 day event. This score had sensitivity of 77.78%, specificity of 81.65%. low positive predictive value of 46.67% but very high negative predictive value of 94.68%. AUROC showed AUROC of 0.797 (p < 0.0001, 95 % confidence interval 0.721-0.874). Pre operative fitness score, Open Surgery and operative time independently predicted an event on multivarious analysis. (p =0.003 and 0.026 respectively.) Conclusions: Pre operative fitness score accurately predicts uneventful post operative course in gastrointestinal and hepatobiliary surgery.

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