2144. Vital Signs Are Vital in Identifying High-Risk Postoperative Patients

Abstract

BackgroundChanges in vital signs are frequently the first sign to point to pathology in the postoperative setting. There is no prediction model that exists that evaluates risk of postoperative complication in real-time. We are interested in understanding if we are able to risk stratify patients after surgery using novel predictors, trajectories of the various vital signs and evaluating their ability to risk stratify patients.MethodsWe reviewed patients who underwent pancreatectomy at an academic health system from January 2015 to February 2018. Postoperative complications were abstracted using definitions set by the National Surgical Quality Improvement Program (NSQIP) and vital signs, including pain score, were extracted from the Data Warehouse. Group-based trajectory modeling, a technique used to identify distinct clusters of patients with similar trajectories, was used to group patients with similar temperature, heart rate, blood pressure and pain scores. Postoperative complications were tabulated for each risk group and chi-square test was used to compare categorical variables.ResultsA total of 195 patients with pancreatectomy were evaluated and the rate of NSQIP complications was 35.4%. Pancreatectomy patients clustered into two distinct clusters for temperature, heart rate, systolic blood pressure and pain score. All four of these vital signs were able to stratify infectious and inflammatory complications between low- and high-risk groups but only systolic blood pressure was significant in stratifying readmission risk and heart rate and pain score for stratifying sepsis risk (Table 1).ConclusionTrends of vital signs may be important predictors of complications. Some vital signs may be better at predicting distinct complications. More work is required to understand if different covariates within trajectory analysis can be combined to further enhance risk stratification for any and specific postoperative complications.Table 1:Rates of Complications by Trajectory AnalysisSepsis %Any Complication %Readmission %Temperature high6.127.0*14.8Temperature low6.841.9*16.2HR high2.8*25.7*13.8HR low11.3*42.5*17.5SBP high6.923.0*9.2*SBP low5.941.2*20.6*Pain score high3.5*27.0*15.7Pain score low10.8*41.2*14.9* Significant at P < 0.05.Disclosures All authors: No reported disclosures.