Differentiated approach to preoperative preparation of patients with various cardiovascular risk in locally advanced cancer of abdominal organs: experimental study

Abstract

INTRODUCTION. Malignant neoplasms of the abdominal organs often lead to exacerbation of cardiovascular diseases or trigger their development. Only proper evaluation of cardiovascular risk allows to effectively prepare for the operation, to choose best option of surgery and to decrease the likelihood of complications in the postoperative period.
 OBJECTIVE. To study the possibility of a differentiated approach to additional preoperative preparation in the surgical treatment of locally advanced cancer of the abdominal organs in patients with different degrees of cardiovascular risk.
 MATERIALS AND METHODS. The first stage included retrospective result analysis of planned surgical treatment of 250 patients under the standard approach to pre-operative examination and preparation. At the second stage, 101 patients were tested a modified algorithm of additional preoperative examination where there was emphasis on persons with an average cardiovascular risk. The observation period did not exceed 30 days. The stratification of perioperative cardiovascular risk was conducted by RCRI and NSQIP-MICA index calculation. Statistical processing of the results was carried out using “Statistica 12.5” application packages (StatSoft, USA).
 RESULTS. The standard approach to preoperative preparation was characterized by relatively high mortality in the early postoperative period (18,4%). Most deaths (54,3% on RCRI scale and 69,5% on NSQIP-MICA scale) were among patients of an average cardiovascular risk. Differentiated algorithm implementation of additional preoperative examination has reduced the incidence of postoperative complications by 2,1-5,9 times, the duration of the patient’s stay in intensive care by 1,4 times and hospital mortality by 2,3 times (up to 7,9%).
 DISCUSSION. The proposed algorithm is focused on the most problematic subgroup of patients with an average cardiovascular risk (1 risk factor on RCRI scale and/or decreased (indefinite) functional status) which, in standard preparation for surgery, have the same chance of an adverse outcome as persons with high comorbidity.
 CONCLUSION. The use of validated methods in evaluating perioperative risk, differentiated approach to additional examination and rational pharmacotherapy reduce hospital mortality in patients with locally advanced cancer of the abdominal organs.