Currently, the incidence of perioperative complications and mortality associated with
surgical intervention are minimized. However, taking into account the significant number
of surgical interventions performed worldwide (more than 300 million per year), the total
number of patients with complicated postoperative periods is large, and postoperative
mortality ranks third in the structure of causes of death (7, 7%), second only to
coronary heart disease and stroke. Moreover, even in discharged patients, complications
that develop can significantly reduce quality of life and worsen long-term prognosis. To
a greater extent, the above applies to high-risk patients, whose identification is a
priority task of anesthesiology.
Identification of risk factors that cause a high probability of an unfavorable outcome is
currently unthinkable without conducting comprehensive prospective population-based
studies, which, on the one hand, make it possible to assess the contribution of many
variables to the risk of complications and mortality, and on the other hand, to maximally
cover a certain population by identifying characteristic predictors for it. To date,
several population-based studies and programs have been described in the literature that
have led to the creation of national databases (registries) of postoperative outcomes.
Such studies include several international (ISOS, EuSOS and ASOS) and national ones, such
as SweSOS [8] or ColSOS , which are at different stages of implementation. Among the
national databases, the best known is the ACS-NSQIP (American College of Surgeons
National Surgical Quality Improvement Program) database, which contains information on
the outcomes of surgical treatment for more than 5 million patients in the United States
since 1991 .
The results obtained from these studies often vary widely, due to the diversity of
approaches to study inclusion criteria, differences in the characteristics of the
populations studied, and the lack of a uniform view on the classification of
postoperative outcomes. When assessing mortality, the authors most often record 30-day
mortality, however, taking into account modern ideas about the role of perioperative
factors and complications in the development of an unfavorable long-term outcome, the
need to determine one-year mortality becomes obvious. As shown by the national
observational study SweSOS, the mortality rate increases significantly over time, with
30-day mortality being 1.8%, 3-month mortality - 3.9%, and 6-month and annual mortality -
5.0% and 8.5% , respectively .
There is also no uniform approach to the registration of postoperative complications, and
modern protocols use several systems, the most common of which are the classification of
the joint working group of ESA (The European Society of Anesthesiologists) and ESICM (The
European Society of Intensive Care Medicine, The European). Society of Intensive Care
Medicine) and the ACS-NSQIP classification (The American College of Surgeons (ACS)
National Surgical Quality Improvement Program (NSQIP)). And although they are similar in
many ways (complications are grouped into blocks according to the nature of the
disorders), differences are also present, and even the same complication may have a
different definition. In addition, some significant outcomes are not included in these
classifications, which predetermines their underestimation.
Of course, one of the advantages of creating a large population-based database is the
recording of a large number of potential predictors of adverse outcome and subsequent
assessment of their individual contribution to the complex perioperative risk. The type
of surgical intervention itself is a factor that largely determines the likelihood of
complications.
The goal is to create a Russian national calculator for the risk of postoperative
complications and mortality.
Primary target points:
Creation of a national register of postoperative outcomes in different areas of
surgery.
Determination of the frequency and structure of outcomes after elective and
emergency surgery.
Identification of predictors of unfavorable outcome.
Development and validation of a model for predicting complications and mortality in
various areas of surgery
Creation of calculators for the risk of postoperative complications and mortality in
various fields of surgery and their integration into a single calculator
Analysis of long-term results in patients with postoperative complications (90 days
and a year after surgery)
Secondary target points:
The role of concomitant diseases in the development of unfavorable outcome
The influence of age on primary and secondary postoperative outcomes
The influence of the type of anesthesia on the course of the postoperative period
The influence of oncological pathology and specific treatment on primary and
secondary postoperative outcomes
The impact of the urgency of surgery on the risk of an unfavorable outcome
Influence of localization, access and duration of surgery on postoperative outcome
Assessment and validation of surgical and anesthesiological risk scales for lethal
outcome (can be listed)
Evaluation and validation of surgical and anesthetic risk scales for primary and
secondary outcomes
Stratification of patients at high perioperative risk with details on cardiac,
respiratory, neurological, renal, hepatic, hemostasiological, infectious and others.
Influence of quality criteria for implementation of FAR recommendations on the
course of the postoperative period
Analysis of the course of ICU-syndrome in patients with complications and depending
on the maximum score on the SOFA scale and the structure of MOF in the postoperative
period
Analysis of the effectiveness of rehabilitation measures in patients with
ICU-syndrome
Analysis of the causes of mortality (based on autopsy reports and clinical and
laboratory data of patients).
Cohort A
The checklist (basic) is filled out for all patients with postoperative complications. At
the same time, the total number of patients operated on in a particular center is taken
into account on a quarterly basis, taking into account their distribution by area of
surgery. Based on the data from the basic checklist, answers will be received to the
following target points:
Creation of a national register of postoperative outcomes in different areas of
surgery.
Determination of the frequency and structure of outcomes after planned and emergency
surgical interventions.
Analysis of long-term results in patients with postoperative complications (90 days
and a year after surgery)
Analysis of the course of ICU-syndrome in patients with complications and depending
on the maximum score on the scale and the structure of MOF in the postoperative
period
Analysis of the effectiveness of rehabilitation measures in patients with ICU
syndrome
Cohort B Basic checklist plus additional checklist: completed for all operated patients
within one selected week quarterly The total number of patients operated on in a
particular center is also taken into account quarterly, taking into account their
distribution by area of surgery.
Based on the data from the basic and additional checklists, answers to the most important
target points (3 primary and 10 secondary) will be obtained:
Identification of predictors of unfavorable outcome.
Development and validation of a model for predicting complications and mortality in
various fields of surgery
Creation of calculators for the risk of postoperative complications and mortality in
various fields of surgery and their integration into a single calculator
The role of concomitant diseases in the development of unfavorable outcome
The influence of age on primary and secondary postoperative outcomes
The influence of the type of anesthesia on the course of the postoperative period
The influence of oncological pathology and specific treatment on primary and
secondary postoperative outcomes
The impact of the urgency of surgery on the risk of an unfavorable outcome
The influence of localization, access and duration of surgery on postoperative
outcome
Assessment and validation of surgical and anesthesiological risk scales for lethal
outcome (can be listed)
Evaluation and validation of surgical and anesthetic risk scales for primary and
secondary outcomes
Stratification of patients at high perioperative risk with details on cardiac,
respiratory, neurological, renal, hepatic, hemostasiological, infectious and others.
Influence of quality criteria for implementation of FAR recommendations on the
course of the postoperative period