Discussion On The Feasibility Of "Post-operative Risk Score Table" Used In The Post-operative Risk Classification Of Severe Abdominal Patients

BackgroundEvery year,there are more than 300 million surgeries in the world,and the number is growing every year.Although the anesthesia related mortality has decreased in recent years,the incidence of severe complications in perioperative patients is still high,so many surgeons and anesthesiologists use ICU as a transfer station for critically ill patients.However,it is not safe for postoperative patients to stay in ICU.One of the most serious death factors of elderly patients in ICU is nosocomial infection,and ICU is one of the medical units with high incidence of nosocomial infection.According to the foreign literature,the incidence rate of ventilator-associated pneumonia is 15%,and the mortality is 38%.Secondly,admission to ICU may bring other hazards to surgical patients,such as long-term forced braking,excessive sedation,sleep deprivation,stress and delirium.Therefore,defining the standard of ICU admission for postoperative patients and standardizing the clinical behavior of postoperative patients can not only guarantee the overall safety of patients in perioperative period,promote the rapid recovery of surgical patients,but also reduce the economic burden of hospitalized patients,the workload of medical staff and save social resources.However,there is not a relatively objective scoring standard on whether patients need to be admitted to ICU.In this study,based on the comprehensive acute physiology and chronic health score(APACHE)and other related perioperative risk score tables,as well as the anesthesia and operation special conditions of patients during the operation,we want to explore a suitable risk assessment table(hereinafter referred to as "post operation risk score table")for the evaluation of critically ill patients after operation anesthesia,which can be used to grade the overall risk of patients after operation,and provide reference for patients after operation It can provide a relatively objective score interval for patients to receive more standardized,safe,reasonable and effective treatment,and also provide clinical reference for anesthesiologists to carry out perioperative comprehensive treatment in the future.ObjectiveTo explore and develop a new type of risk scale for assessment of critically ill patients at the end of operation,so as to provide guidance for admission in intensive care unit(ICU)after surgery.MethodsThe clinical data of patients who underwent abdominal surgery and were admitted to ICU from January 2017 to December 2018 were retrospectively analyzed in 3Agrade hospital.The patients were divided into two groups:group A and group B.Patients in group A received organ function support and close monitoring in ICU after operation,and were considered necessary to stay in ICU.Those in group B did not re-ceive organ function support or close monitoring in ICU,and were considered unnecessary to stay in ICU.A self-made postoperative risk scale was used to evaluate the patients,and their scores and 95%confidence interval(CI)were obtained.The postoperative risk score which was ≥ the lower limit of 95%CI in group A was set as the criteria for admission to ICU,while the postoperative risk score which was≤the lower limit of 95%CI in group B were set as the criteria for returning to the ward.The error rate of patients in group A and group B was calculated.Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)was used as a control to evaluate the postoperative risk score and the receiver operating characteristic(ROC)curve was plotted to evaluate the accuracy of the risk score in predicting admission to ICU or returning to ward.There were 202 patients in group A and 322 patients in group B.There was no significant difference in the risk scores among patients in the three hospitals(P>0.05).The risk score was 16.87±4.02(95%CI 16.22-17.48)for group B and 24.57±6.23(95%CI 23.32-25.75)for group A.There was significant difference in the risk scores between two groups(P<0.05).The error rate was 3%for group A and 6%for group B.The area under ROC curve was 0.866(95%CI 0.818-0.914),with a sensitivity of 0.755 and a specificity of 0.830.ConclusionThe postoperative risk score has a good guidance for critically ill patients to enter.Patients with≥23 scores are strongly recommended for ICU stay.Those with≤16 scores are suggested not to stay in ICU.If the score ranges from 17 to 22,the patients are suggested to admit into post-anesthesia care unit(PACU)or receive the rapeutic regimens suggested by anesthesiologists and surgeons based on their other clinical conditions.