The Extended Postoperative Care-Score (EXPO-Score)-An Objective Tool for Early Identification of Indication for Extended Postoperative Care.

Jochen Renner,Amke Caliebe,Markus Steinfath,Maj-Britt Hertz,Jan Höcker,Timo Iden,Matthias Gruenewald,Päivi Suvanto-Scholz,Norbert Weiler

doi:10.3390/jcm8101666

Abstract

Extended postoperative care and intensive care unit capacity is limited and efficient patient allocation is mandatory. This study aims to develop an effective yet simple score to predict indication for extended postoperative care, as there is a lack of objective criteria for early prediction of admission to extended care in surgical patients. This prospective observational study was divided into two periods (Period 1: Extended Postoperative Care-Score (EXPO)-Score generation; Period 2: EXPO-Score validation) and it was performed at a tertiary university center in Germany. A total of 4042 (Period 1) and 2198 (Period 2) adult patients ≥ 18 years old receiving elective or emergency surgery were included in this study. After identifying patient- and surgery-related risk factors by an expert panel, the EXPO-Score was developed through logistic regression from data of Period 1 and validated in Period 2. Three risk factors are sufficient for generating a reliable predictive EXPO-Score: (1) the American Society of Anesthesiologists’ (ASA) physical status, (2) cardiopulmonary physical exercise status expressed in metabolic equivalents (MET), and (3) the type of surgery. The score threshold (0.23) has a sensitivity of 0.87, a specificity of 0.91, and an accuracy of 0.90 for predicting indication for extended postoperative care. The EXPO-Score provides a validated, early collectable, and easy-to-use tool for predicting indication of extended postoperative care in adult surgical patients.

Highlights

Appropriate patient allocation to the Intensive Care Unit (ICU) and similar units of extended postoperative care is important due to its high cost and limited capacity
In this prospective study, we developed and validated the Extended Postoperative Care-Score (EXPO)-Score, an objective, high precision, interpretable predictive tool for extended postoperative care indication in surgical patients
We developed and validated the EXPO-Score, an objective, high precision, interpretable predictive tool for extended postoperative care indication in surgical patients

Summary

Introduction

Appropriate patient allocation to the Intensive Care Unit (ICU) and similar units of extended postoperative care is important due to its high cost and limited capacity. As compared to cardiac surgery with excessive postoperative ICU admission rate, only 15% to 35% of high-risk non-cardiac surgical patients are admitted to the ICU [4,5]. The overall mortality rate of cardiac surgery patients is only 3.5% as compared to 12.2% in high-risk non-cardiac surgery [5]. While more standardized surgical and anesthesiological approaches in cardiac surgery may have contributed to its lower mortality rate, the alarming differences in ICU admission and mortality rates suggest inadequate ICU admission for non-cardiac surgery patients. There is an urgent need for improving preoperative prediction of postoperative extended care indication in order to plan and provide safe postoperative care within the limits of capacity and cost

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Conclusion