Screening Models for Cardiac Risk Evaluation in Emergency Abdominal Surgery. II. Evaluation of the Postoperative Period Risk based on Data from the Pre- and Intraoperative Period
A classification of intraoperative (IO) and postoperative (PO) cardio-vascular complications (CVC) was performed, based on data from 466 patients subjected to emergency surgery, due to severe abdominal surgical diseases or traumas, in accordance with the severe criteria of ACC/AHA in CVC for non-cardiac surgery. There were 370 intra and 405 postoperative (IO; PO) CVC registered, distributed as follows: groups with low risk (IO: 148; PO: 87), moderate risk (IO: 200; PO: 225), and high risk (IO: 22; PO: 93). Patient groups were formed, according to the CVC risk level, during the intra- and postoperative periods, for which the determinant factor for the group distribution of patients was the complication with the highest risk. Individual data was collected for each patient, based on 65 indices: age, physical status, diseases, surgical interventions, anaesthesiological information, intra and postoperative cardio-vascular complications, disease outcome, causes of death, cardio-vascular disease anamnesis, anamnesis of all other nonsurgical diseases present, laboratory results, results from all imaging and instrumental examinations, etc. The trend toward increase or decrease of the CVC risk was studied during the transition from intra- to the postoperative period. On the basis of these indices, a new distribution of the patients was implemented, into groups with different levels of risk of CVC during intra- and postoperative. This result is a solid argument, substantiating the proposal to introduce these adjustments to the ACC/AHA criteria for determining the severity of CVC in the specific conditions of emergency abdominal surgery
