International Medical Journal, Vol. 24., Iss. 1, 2018, P. 39−42.
PROGNOSIS OF OPERATIVE AND ANESTHESIOLOGICAL RISK IN BARIATRIC SURGERY WITH P-POSSUM SCALE
Center for Innovation Technologies of National Academy of Sciences of Ukraine, Kyiv, Ukraine
Severity of somatic condition of the patients with obesity and complexity of surgical procedures determine the relevance of surgical−anesthetic risk objectification in bariatric surgery because accurate assessment of the perioperative risk allows to determine the optimal tactics and duration of the patient preparation for the surgery as well as effectively levels the risks of intraoperative and early postoperative complications, reduce the number of refusal to operate the patients. To improve the results of surgical treatment of morbid obese patients, the reliability of prediction of early postoperative complications and mortality using P−POSSUM was assessed in patients with morbid obesity, which underwent sleeve gastrectomy or biliopancreatic diversion with duodenal switch in Hess−Marceau modification. Subsequently, the predicted and the true number of early postoperative complications and lethality (during the first 30 days of the postoperative period) were compared using P−POSSUM. Non−parametric methods of statistical analysis (Mann−Whitney U−criterion) were used to assess the reliability of the relationship between the indicated events. The expected level of early postoperative complications in patients included in P−POSSUM study was 30.7±13.4 %. In fact, early postoperative complications occurred in 17 (8.3 %) patients. There were no fatal cases in the early postoperative period. The total correlation of actual to the predicted number of early complications of 0.27 and actual/predicted mortality of 0 showed a significant overassessment of their risk according to P−POSSUM. The results of the study indicate that the use of P−POSSUM in bariatric surgery leads to a significant overassessment of the risk of complications and mortality in the early postoperative period and may cause unwarranted failure of patients to undergo bariatric surgery.
Key words: morbid obesity, postoperative morbidity, mortality, prognosis.