Surgical Scoring System Research Articles

Optimizing surgical approaches for anterior communicating artery aneurysms: Development and internal validation of a novel surgical scoring system.

The objective was to provide comprehensive preoperative information on both the aneurysm orientation and the side and method of surgical approach for optimal preoperative information and safe clipping using 3D imaging modalities. This was achieved by making an objective risk assessment on the surgical side/method and evaluating its effectiveness with internal validation. Radiologic data of 61 ACoA aneurysm patients between 2012 and 2020 were retrospectively analyzed. A scoring system based on five criteria; ACoA aneurysm dome orientation, A1 symmetry/control, perforating artery control, A2 trace orientation, and A2 fork symmetry was developed. The system is designed to align with the most common surgical approaches in ACoA aneurysm surgery. The patients were categorized into three groups based on the scoring results to determine the most appropriate surgical method. Group I was recommended, Group II was less recommended, and Group III was least recommended. Internal validation was performed to assess the system's effectiveness. Outcomes and complication rates were statistically evaluated. When the scoring system was utilized, the mean score difference between the first group and the other groups was 2.71 and 4.62, respectively. There was a homogeneous distribution among the groups in terms of age, sex, WFNS, and Fisher scores. Complication occurred in three patients in Group I and nine patients each in Group II and Group III. The further the deviation from the first option, the higher the complication rate (p = 0.016), and a significant cause-effect relationship was identified (p = 0.021). The ROC curve established a cut-off value of 12.5 points for complications and outcomes. Our study introduces a new scoring system for ACoA aneurysms, enhancing the use of 3D CTA in daily practice and providing internal validation for the proposed approach. By evaluating objective criteria, this scoring system helps predict surgical risks, prevent complications, and supports personalized evaluation and selection of the surgical approach based on objective criteria.

ThTP7.6 COLORECTAL SURGERY VIRTUAL WARD, AN ADJUNCT TO ERAS GUIDELINES

Abstract Enhanced Recovery after Surgery (ERAS) guidelines provide enhanced recovery protocols after Colorectal Surgery, resulting in reduced morbidity and length of stay without readmissions. A digital way of achieving this will be via Virtual Wards, which offer the use of wearable technology for symptoms and signs utilizing scoring systems at the comfort of home resulting in early discharge. Although the technology exists and is being implemented in many places no specific surgical scoring system has been developed or validated to monitor specific postoperative parameters at home. We offer “a colorectal virtual ward model” with a dedicated scoring system to virtually monitor patients at home and reduce 30 days readmissions. Secondary aim of our project is accelerated discharges in line with ERAS. Method A novel “Leicester Virtual ward model” was developed after a literature review. Pre tested scoring systems to categorize the common 1st 30 days post complications were merged with modified NEWS score. A software was designed utilizing a warning system to handle red flags or a combination of different green, red and amber scenarios. Patients will be trained and sent home with gadgets and app based questionnaire for daily monitoring. Results In the initial phase the virtual ward is being used to reduce readmission rates. In the second phase it will be used for an accelerated discharge of patients allowing remote monitoring with telephone/virtual or face to face advice as needed. Conclusion Virtual wards will be a technology-based solution to increase compliance with ERAS by providing support and outpatient surveillance.

The use of transesophageal echocardiography to predict surgical complexity scoring system for degenerative mitral valve repair.

For severe mitral valve (MV) degenerative disease, repair is recommended. Prediction of repair complexity and referral to high volume centers can increase rates of successful repair. This study sought to demonstrate that TEE is a feasible imaging modality to predict the complexity of surgical MV repair. Two hundred TEE examinations of patients who underwent MV repair (2009-2011) were retrospectively reviewed and scored by two cardiac anesthesiologists. TEE scores were compared to surgical complexity scores, which were previously assigned based on published methods. Kappa values were reported for the agreement of TEE and surgical scores. McNemar's tests were used to test the homogeneity of the marginal probabilities of different scoring categories. TEE scores were slightly lower (2[1,3]) than surgical scores (3[1,4]). The agreement was 66% between the scoring methods, with a moderate kappa (.46). Using surgical scores as the gold standard, 70%, 71%, and 46% of simple, intermediate and complex surgical scores, respectively, were correctly scored by TEE. P1, P2, P3, and A2 prolapse were easiest to identify with TEE and had the highest agreement with surgical scoring (P1 agreement 79% with kappa .55, P2 96% [kappa .8], P3 77% [kappa .51], A2 88% [kappa .6]). The lowest agreement between the two scores occurred with A1 prolapse (kappa .05) and posteromedial commissure prolapse (kappa .14). In the presence of significant disagreement, TEE scores were more likely to be of higher complexity than surgical. McNemar's test was significant for prolapse of P1 (p=.005), A1 (p=.025), A2 (p=.041), and the posteromedial commissure (p<.0001). TEE-based scoring is feasible for prediction of the complexity of MV surgical repair, thus allowing for preoperative stratification.

The Role of CT Angiography to Predict the Shamblin Group in Carotid Body Tumors.

Carotid body tumors (CBTs) are uncommon benign head and neck neoplasms. Surgical resection is the treatment of choice for CBTs. However, the anatomical structures adjacent to the tumor tissue may encounter serious injuries during the surgery. Shamblin grading system is a surgical intra-operative scoring system to determine the risks associated with the surgery. Therefore, we aimed to evaluate the correlation of pre-surgical imaging parameters with Shamblin grades and intra-operative complications. In this cross sectional study, we enrolled 36 patients with CBTs. Preoperative cervical CT angiography was acquired in each participant and following parameters were reported in each case: Tumor volume, tumor distance to the base of the skull (TDBS), tumor contact with the internal carotid artery (ICA), and external carotid artery (ECA) and tumor density. Finally, we assessed the relation of pre-surgical imaging parameters with Shamblin grades, and intra-operative complications. Only tumor volume was significantly correlated with Shamblin grades (P < 0.05). The tumor contact with ECA was marginally correlated with Shamblin grades (P = 0.103); however, other imaging parameters were not significantly correlating with Shamblin grades. There was a statistically significant correlation between ICA contact and tumor volume with ECA injury. In addition, the tumor density significantly correlated with cranial nerves injury. The results of STATA analysis were indicative for 69.44% accordance between radiologic typing and Shamblin grading system. We found that tumor volume correlates significantly with Shamblin grading system, and there is significant correlation between tumor ICA contact, and tumor density and intra-operative complications.

Comparison of different scoring systems in predicting mortality and postoperative complications in acute care surgery patients at a Saudi Academic Centre.

Emergency surgery carries an increased risk of death and complications. Scoring systems can help identify patients at higher risk of mortality and complications. Scoring systems can also help benchmark acute care services. This study aims to compare different scoring systems in predicting outcomes among acute care surgery patients. Our study is a retrospective cohort study that included all adult emergency surgery admissions between 2017 and 2019. Data were obtained from patients' electronic health records. Same admission mortality and postoperative complications were collected. Data were recorded to calculate the American Society of Anesthesiologists Physical Status classification system (ASA-PS), Shock Index Score (SI), Age Shock Index Score (AgeSI), and the Emergency Surgery Score (ESS). The probability of death and complications was correlated with each scoring system and was assessed by calculating the c-statistic. During the study period, 1606 patients fulfilled inclusion criteria. The mortality rate was 2.2%, complication rate was 18.7%. ESS predicted mortality with a c-statistic of 0.87 better than ASA-PS, AgeSI, and SI with a calculated c-statistic of 0.81, 0.74, and 0.57, respectively. ESS also predicted the occurrence of complications with a c-statistic of 0.83 better than ASA-PS, AgeSI, and SI with a calculated c-statistic of 0.72, 0.71, and 0.63, respectively. ESS demonstrated a better prognostic accuracy for hospital mortality and postoperative complications than other prognostic scoring systems. Our findings suggest that a scoring system designed for the acute care surgical population may provide enhanced prognostic performance over other surgical prognostic scoring systems.

Application of AAGL Endometriosis Classification - An Innovative Tool with Additional Contributions

<h3>Study Objective</h3> To demonstrate application of the innovative newly developed AAGL 2021 endometriosis anatomy-based surgical complexity scoring system and add further contributions. <h3>Design</h3> An overall step-by-step application of the new surgical scoring system developed in 2021 with emphasis on pragmatic utilization of the App through two case reports. <h3>Setting</h3> A university hospital based on Detroit, Michigan; Wayne State University/ Detroit Medical Center <h3>Patients or Participants</h3> A series of two case reports of stage 4 endometriosis based on the Scoring System, including one with endometriosis on the diaphragm. Each patient case demonstrates variety of symptoms and challenges - including pelvic pain and abdominal pain. <h3>Interventions</h3> Application and utilization of the AAGL 2021 Endometriosis Classification. <h3>Measurements and Main Results</h3> Successful identification of intra-operative endometriosis with staging on the AAGL 2021 Endometriosis Classification Scoring System. <h3>Conclusion</h3> Application of AAGL 2021 Endometriosis Classification remains to be very effective in surgical complexity scoring. The classification offers an alternative point system in quantifying endometriotic lesions. This point system allows for a way to numerically scale the disease from a surgical complexity standpoint. Due to its intraoperative utility, the AAGL Endometriosis Classification correlates to pain and avoids limitations that noninvasive imaging may experience and focuses predominantly on pain symptoms. Additional contributions may include addition of extra-pelvic endometriosis, such as the diaphragm. The overall goal is to improve care of endometriosis patients, from addressing chronic pelvic pain, abdominal pain, and fertility complications, with an objective intraoperative staging system.

8977 The Use and (Potential) Misuse of the AAGL Endometriosis Classification System

<h3>Study Objective</h3> To demonstrate use and (potential) misuse of the AAGL 2021 Endometriosis Classification Scoring System, an anatomy-based surgical complexity scoring system - with the goal of optimizing future endometriosis staging. <h3>Design</h3> A case report applying the new AAGL 2021 Endometriosis Classification and use of the App. <h3>Setting</h3> A university hospital based in Detroit, Michigan; Wayne State University/ Detroit Medical Center. <h3>Patients or Participants</h3> A case report of a Stage 2 Endometriosis based on the Scoring System with a patient presenting for infertility. <h3>Interventions</h3> Application and utilization of the AAGL 2021 Endometriosis Classification for a Stage 2 Endometriosis Classification. <h3>Measurements and Main Results</h3> Scoring system demonstrated feasibility, applied utility to the correlation that was discussed regarding the Scoring System, but also limitations and potential misuses of the scoring system. <h3>Conclusion</h3> The AAGL Endometriosis Scoring System is a feasible intraoperative scoring system correlated with pain. It is critical to be cognizant of staging parameters while scoring the endometriotic lesions and remaining consistent.

The utility of surgical Apgar score in predicting postoperative morbidity and mortality in general surgery.

Many surgical scoring systems are used to predict operative risk but most are complicated. The aim of the study was to determine the utility of the Surgical Apgar Score (SAS) in predicting post operative mortality and morbidity in general surgical cases. This was a prospective observational study. All adult patients for emergency and elective general surgical procedures were included. Intraoperative data was collected, and post operative outcomes were followed up till 30 days. SAS was calculated from intraoperative lowest heart rate, lowest MAP and blood loss. A total of 220 patients were included in the study. All consecutive general surgical procedures were included. Sixty of the 220 cases were emergency and the rest were elective. Forty-five (20.5%) of the patients developed complication. Mortality rate was 3.2% (7 out of 220). The cases were divided into high risk (0-4), moderate risk (5-8) and low risk (9-10) based on SAS. Complication and mortality rates were 50% and 8.3% in the high risk group, 23% and 3.7% in the moderate risk and 4.2% and 0 in the low risk group, respectively. The surgical Apgar score is a simple and valid predictor of postoperative morbidity and 30-day mortality among patients undergoing general surgeries. It is applicable to all types of surgeries for emergency and elective cases and irrespective of the patient general condition and type of anesthesia and surgery planned.

Scoring the Positive Margin Status in Partial Nephrectomy

Objective A clear resection margin is one of the trifecta outcomes in partial nephrectomy. We proposed a positive surgical margin scoring system and implemented it in our cases to assess its effect on the oncological outcomes.MethodsRetrospective review of prospectively collected multi-center data was performed for all the partial nephrectomy (PN) procedures performed between April 2009 and August 2019. Demographic data, RENAL nephrometry score, peri-operative data and margin status were collected. Positive surgical margin (PSM) cases were given a scoring system of I, II and III for PSM that are &lt;3mms, 3-5mms and &gt;5 mms, respectively. Postoperative, oncological results and adverse events were using Stats Direct. Data analysis was performed using t-test. Comparative data between the two groups was calculated using z-score calculator. p values of 0.05 or less were considered statistically significant.Results A total of 339 PN procedures were performed for histologically proven renal cancer. Forty four patients had PSM. There were 17, 16 and 11 patients with score I, II and III PSM, respectively. Those with a high RENAL nephrometry score had the highest rate of PSM (n=21) as opposed to the intermediate (n=13) and the low (n=10) score groups. After an average follow up of 38 months (10-132), a total of 21 recurrences were recorded; 14 had clear resection margins, 7 were PSM (PSM-I=1. PSM-II=2, PSM-III=4, respectively). ConclusionOverall patients with PSM status have a low chance of recurrent or metastatic disease although those with a wider PSM (III) have a higher chance of recurrent and/or metastatic disease. Tumour grade and pathological T-stage are independent factors for recurrence/metastasis. Larger cohort and longer follow up would be recommended.

Amit Jain’s surgical scoring system and its ability in predicting the major amputation in diabetic foot complications

There are numerous scoring system used in different parts of the world and most of them are for diabetic foot ulcers only with Amit Jain’s surgical scoring system being the first such scoring for diabetic foot complications. This study aims to validate the Amit Jain’s scoring system in predicting the risk of major amputation in diabetic foot complications. A retrospective analysis was done in Department of General Surgery of Raja Rajeswari medical college, Bengaluru, India. The study period was from January 2018 to December 2019. All the patients who underwent surgeries for diabetic foot complications in our department were included in the study. A total of 47 patients were included in this study. Majority of patients (76.6%) were males 61.7% of patients had diabetes mellitus of less than 10 years duration. Abscess was the most common pathological lesion seen in the foot affecting 36.17%. Most of the patients (59.6%) with diabetic foot complications had Amit Jain’s surgical score of 6-10 and were in low risk category. 12 patients (25.5%) underwent major amputation in this study and a significant association (P&lt;0.001) was noted between Amit Jain’s surgical scoring and major amputation.

Scoring systems for the management of oncological hepato-pancreato-biliary patients.

Oncological scoring systems in surgery are used as evidence-based decision aids to best support management through assessing prognosis, effectiveness and recurrence. Currently, the use of scoring systems in the hepato-pancreato-biliary (HPB) field is limited as concerns over precision and applicability prevent their widespread clinical implementation. The aim of this review was to discuss clinically useful oncological scoring systems for surgical management of HPB patients. A narrative review was conducted to appraise oncological HPB scoring systems. Original research articles of established and novel scoring systems were searched using Google Scholar, PubMed, Cochrane, and Ovid Medline. Selected models were determined by authors. This review discusses nine scoring systems in cancers of the liver (CLIP, BCLC, ALBI Grade, RETREAT, Fong’s score), pancreas (Genç’s score, mGPS), and biliary tract (TMHSS, MEGNA). Eight models used exclusively objective measurements to compute their scores while one used a mixture of both subjective and objective inputs. Seven models evaluated their scoring performance in external populations, with reported discriminatory c-statistic ranging from 0.58 to 0.82. Selection of model variables was most frequently determined using a combination of univariate and multivariate analysis. Calibration, another determinant of model accuracy, was poorly reported amongst nine scoring systems. A diverse range of HPB surgical scoring systems may facilitate evidence-based decisions on patient management and treatment. Future scoring systems need to be developed using heterogenous patient cohorts with improved stratification, with future trends integrating machine learning and genetics to improve outcome prediction.

Surgical Apgar Score: Utility in Predicting Postoperative Outcome in Cases of Exploratory Laparotomy

Aims and Objective: The aim of this study is to correlate SURGICAL APGAR score in predicting post-operative mortality and morbidity.&#x0D; Materials and Method: This was a prospective study. All patients fulfilling the inclusion criteria in Krishna institute of medical sciences karad were included in the study which was conducted from December 2019 to July 2021. All patients undergoing exploratory laparotomy were scored according to surgical Apgar scoring system and their score was correlated with post-operative outcome.&#x0D; Result: In our study, the mean surgical Apgar score among study subjects was 4.68 ±1.67. Majority of the study subjects had surgical APGAR score between 5 to 6 (51.43%), followed by 3 to 4 (28.57%). The p&lt;0.0001 is highly significant in our study. Statistically significant results were seen in the score groups, with score groups of 0-2 showing 7.14%, 3-4 with 2.85%, 5-6 with 1.42%, 7-10 with 0% mortality.&#x0D; Conclusion: From the study it was concluded that SURGICAL APGAR score is an excellent predictor of post operative outcomes in regard to complications and mortality.

Evaluation of the educational quality and reliability of YouTube videos addressing eyelid ptosis surgery

ABSTRACT Purpose To evaluate the educational content, quality, and reliability of YouTube videos addressing anterior approach ptosis surgery. Methods A search on YouTube using the term “ptosis surgery” was performed between March 20 and March 26 2021. The quality, reliability, and accuracy of the contents of 38 videos meeting the inclusion criteria were evaluated by two independent ophthalmologists using the DISCERN questionnaire and the Journal of the American Medical Association (JAMA) benchmark criteria. The Global Quality Score (GQS) and a surgical scoring system were used to assess the educational value of the content. Results The mean DISCERN score was 32.8 ± 10, and the mean JAMA score was 1.3 ± 0.5, indicating poor quality; the mean global quality score was 3.1 ± 1.1, indicating moderate quality; and the mean surgical score was 7.5 ± 2.7, indicating moderate to good quality. The surgical, DISCERN, and GQS scores of the videos uploaded by physicians were significantly higher than those of the videos uploaded by private clinics (p = .015, p= .049, and p= .01, respectively). There was a significant positive correlation between the surgical, DISCERN, JAMA, and GQS scores (p< .001). A significant positive correlation was found between video duration and surgical score (p= .013), DISCERN score (p ˂0.001), and GQS score (p ˂0.001). Conclusion Videos with known sources, uploaded by physicians, and supported by audio narration may be useful in obtaining educational information. However, the available videos are not a reliable source of educational information about ptosis surgery.

Mobility aids predict mortality after transcatheter aortic valve implantation.

Selection of appropriate patients for transcatheter aortic valve implantation (TAVI) can be challenging. Many factors can influence post-procedure outcomes. Traditional surgical scoring systems do not discriminate effectively. Medical parameters and functional indices can characterize mortality risk. Mobility is an important predictive functional index but is largely defined using subjective criteria. To describe the relationship between mobility, objectively defined by the requirement for gait aids to ambulate, and all-cause 30-day and long-term mortality in patients undergoing TAVI. Mobility aid use was assessed in 1444 consecutive patients undergoing TAVI in a single center. Patients were categorized into "unaided," "1-stick," and "higher aid" groups based on the Brighton Mobility Index. Mortality tracking was obtained via the NHS Spine Portal in February 2021. Patients were aged 82 (IQR 78-86). 66% of patients walked unaided, 26% walked with 1 stick, and 8% required more assistance (e.g., 2 sticks, a Rollator, a Zimmer frame, or a wheelchair). Overall 30-day mortality for the whole cohort was 3.5%; 1-year mortality was 12.2%. Mobility was a significant predictor of 30-day mortality (p=0.025). Use of a higher aid was associated with a mortality odds ratio of 2.83 (95% CI: 1.39-5.74). Mobility was also a significant predictor of long-term mortality (p < 0.001). Odds ratios for 1-stick and higher aid groups were 1.45 (95% CI: 1.21-1.72) and 2.01 (95% CI: 1.55-2.60), respectively. Objective assessment of mobility by gait aid use predicts both short and long-term survival in patients undergoing TAVI. Increased dependence on mobility aids is associated with a worse prognosis.

473 A Review of The Risk Stratification Models Used in The Management of Oncological Hepato-Pancreato-Biliary Surgical Patients

Abstract Introduction Oncological scoring systems in surgery are used as evidence-based decision aids to best support management through assessing prognosis, effectiveness and recurrence. Currently, the use of scoring systems in the hepato-pancreato-biliary (HPB) subspecialty is limited as concerns over precision and applicability prevent widespread clinical implementation. The aim of the review is to discuss clinically useful oncological scoring systems for the surgical management of HPB patients. Method Primary articles of validated novel and established scoring systems were searched over a 25-year period using PubMed, Cochrane and Ovid Medline. Results This review discusses 9 clinically useful scoring systems in cancers of the liver (CLIP, BCLC, ALBI Grade, RETREAT, Fong et al.), pancreas (Genc et al., mGPS) and biliary tract (TMHSS, MEGNA). CLIP and BCLC are extensively validated prognostic tools, with BCLC clinically endorsed by guidelines. Conversely, patient and treatment stratification is limited in CLIP and BCLC respectively - ALBI works to improve patient stratification. RETREAT, Fong et al. and Genc et al. scores predict recurrence following surgery, however these scores require further validation in heterogenous patient groups. mGPS and MEGNA are simple prognostic scores, but also require further validation in varied patient cohorts. TMHSS is user-friendly, however is limited at discriminating treatment for the middle patient group. Conclusion A diverse range of HPB surgical scoring systems may facilitate evidenced-based treatment decisions and improve management. Future scoring systems need to be developed on heterogenous patient cohorts with improved stratification, with current trends towards implementing machine learning and genetics to improve outcome prediction.

Microsurgical resection of foramen magnum meningioma: multi-institutional retrospective case series and proposed surgical risk scoring system.

Foramen magnum meningiomas (FMMs) are a major surgical challenge, due to relevant surgical morbidity and mortality. The paper aims to review the clinical (symptomatic improvement, complication rate, length of hospital stay) and radiological outcome (completeness of resection) of microsurgical resection of FMMs, and to identify predictors of complications. A multi-institutional retrospective review of prospectively maintained database of FMMs included 51 patients (74.5% females) with a median tumor volume of 8.18cm3 (range, 1.77-57.9cm3) and median follow-up of 36months (range, 0.30-180.0months). Tumors were resected though suboccipital approach (58.8%) or posterior-lateral approaches (39.3%), including far-lateral, extreme lateral and transcondylar approaches. Gross-total resection (GTR) was achieved in 80.4% and 98% of cases did not present tumor regrowth or recurrence. Clinical symptoms improved in 34 patients (66.7%) and worsened in 5 (9.8%). The median length of hospital stay was 5days. Mortality was null. Postoperative complications developed in 15 patients (29.4%), with cerebrospinal fluid leak (7.8%) and lower cranial nerves deficits (7.8%) as the most frequent. Craniospinal location (p = 0.03), location anterior to the dentate ligament (DL) (p = 0.02), involvement of vertebral artery (VA) (p = 0.03) were significantly associated with complication rate. These three elements allow calculating the Foramen Magnum Meningioma Risk Score (FRMMRS), to estimate the risk of post-operative complications. Microsurgical resection allows for high GTR rate and low rate of tumor regrowth or recurrence, despite complications in one third of the patients. The FMMRS allows classifying FMMs and estimating the risk of post-operative complications.

Development and Assessment of an Otolaryngology-Specific Surgical Priority Scoring System.

ObjectiveTo develop and assess an otolaryngology-specific surgical priority scoring system that incorporates varying levels of mucosal involvement.Study DesignRetrospective cohort.SettingAcademic medical center.MethodsA novel mucosal score was developed based on best available evidence. This mucosal score was incorporated into the Medically Necessary, Time-Sensitive (MeNTS) score to generate a MeNTS-Mucosal (MeNTS-M) score. A retrospective cohort of patients was identified to assess the surgical priority scoring systems. Inclusion criteria included all scheduled surgical procedures between March 23, 2020, and April 17, 2020. Decisions about whether to proceed or cancel were made based on best clinical judgment by surgeons, without use of any surgical priority scores. The predictive value of the surgical priority scoring systems was assessed in this retrospective cohort.ResultsThe median MeNTS score was significantly lower in adult patients whose surgery proceeded compared to those for whom the surgery was cancelled (48 vs 56; P = .004). Mucosal and MeNTS-M scores were not statistically different based on whether surgery proceeded. Among adult patients, the highest area under the curve (AUC) was for the MeNTS scoring system (0.794); both the mucosal and MeNTS-M systems had lower AUC values (which were significantly lower than the AUC for the MeNTS scoring system).ConclusionThis study represents development and assessment of the first otolaryngology-specific surgical priority score and incorporates varying levels of mucosal disruption. The combined MeNTS-M scoring system could be a valuable tool in appropriately triaging otolaryngology–head and neck surgery procedures.

Experience with the use of HIPEC in advanced serous ovarian cancer after complete and optimal cytoreduction.

Ovarian cancer (OC) is one of the most demanding unresolved issues in oncogynecology. In Ukraine, there are over 3000new cases of the disease annually. 24.6% of patients die within the first year after diagnosis. It indicates the relevance of developing new and optimizing existing OC treatment programs. To analyze the short-term results of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with primary (non-recurrent) advanced serous OC, in comparison with the group of patients after standard cytoreductive surgery (CRS) of high and medium complexity, according to the following indicators: the effect on metabolism, postoperative complications, length of stay in intensive care unit and hospital, timing of adjuvant chemotherapy initiation. Cases of 35patients with advanced serous OC who underwent the treatment at the Oncogynecology Department of the National Cancer Institute from December 2018to April 2020were analyzed. For the assessment of surgical procedures volumes, a surgical complexity scoring system was used. HIPEC was performed in 20patients (57.1%), while 15patients (42.9%) underwent standard CRS. At the beginning and end of the HIPEC procedure, a shift in acid-base state and the development of hyperthermia were evident. At the end of the 1st day of the postoperative period, statistically significant changes (p< 0.05) were revealed in pH, base excess, body temperature, alanine transaminase and aspartate transaminase levels in patients from HIPEC group indicating the development of metabolic acidosis and toxic liver damage. The negative effects of HIPEC developed at the end of the procedure may persist at the end of the first postoperative day. While metabolic acidosis diminishes, the signs of hepatotoxicity persist. Toxic liver damage is the most frequent complication of the postoperative period detected more often (p< 0.05) after HIPEC in comparison with standard CRS. Standard adjuvant chemotherapy began on average in 31.9± 4.4days in HIPEC group and 18.6± 1.6days in CRS group (p< 0.05). The data obtained indicate that HIPEC negatively affects metabolism and aggravates the severity of disorders that develop during the CRS phase. The use of HIPEC postpones the initiation of adjuvant chemotherapy, which is probably associated with a longer period of restoration of the functions of organs and systems of patients (in particular, liver function). The feasibility of HIPEC in advanced serous OC treatment requires further research.

A PROSPECTIVE STUDY TO DETERMINE POST OPERATIE MORBIDITY AND MORTALITY USING SURGICAL APGAR SCORE

Introduction: Predicting the post-operative complication earlier will help surgeons take necessary precautions Pre and Peri-operatively. It reduces the direct as well as indirect medical cost. The main risk factors which have effect on morbidity as well as mortality are Age ,Type of surgery, History of Diabetes, Hypertension, Smoking, Renal disease, Cardiovascular disease, COPD, Asthma, steroid intake etc. Atul Gawande et al developed a scoring system as a boon for surgeons termed as surgical Apgar scoring system. Though initially devised for Colorectal surgeries this scoring system can be applied for general surgical procedures and predicts major complications as well as mortality using Lowest Heart Rate intra operatively, Lowest Mean Arterial Pressure intra operatively and Estimated Blood Loss. Existing prediction scoring system that involve lab investigation needs meticulous procedure. Hence this study is being carried out to evaluate the ability of Surgical APGAR score to predict post-operative morbidity and 30 days for General Surgical procedures. Materials and methods: Descriptive longitudinal study carried out at Department of General surgery, Meenakshi Medical College &amp; Research Institute, Kanchipuram, Tamil Nadu, for a period of 12 months With a sample size of 200 Inclusion criteria: Patients aged between 15-75 years undergoing Emergency or Elective General surgical procedures under General, Spinal or Epidural anesthesia. Exclusion criteria: Patient on Beta Blockers and those undergoing procedures under Local Anesthesia were excluded. Results: Among the comorbid conditions COPD, Asthma and Renal failure have statistically significant association with Surgical Apgar score. There is statistically significant association between type of surgery and Surgical Apgar score. There is statistically significant association between Surgical Apgar score and complications. There is statistically significant association between surgical Apgar score and mortality. Among 8 individuals who had high risk score 6 individuals had mortality. Conclusion: The 10-point Surgical Apgar Scoring system is an easy and fairly accurate method of identifying the patients at risk of complications and mortality in the post-operative period. Patients with low surgical Apgar score would require more intensive monitoring in the postoperative period even if they are undergoing a minor procedure.

Current Surgical Risk Scores Overestimate Risk in Minimally Invasive Aortic Valve Replacement.

Risk-scoring systems for surgical aortic valve replacement (AVR) were largely derived from sternotomy cases. We evaluated the accuracy of current risk scores in predicting outcomes after minimally invasive AVR (mini-AVR). Because transcatheter AVR (TAVR) is being considered for use in low-risk patients with aortic stenosis, accurate mini-AVR risk assessment is necessary. We reviewed 1,018 consecutive isolated mini-AVR cases (2009 to 2015). After excluding patients with Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) scores ≥4, we calculated each patient's European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, TAVR Risk Score (TAVR-RS), and age, creatinine, and ejection fraction score (ACEF). We compared all 4 scores' accuracy in predicting mini-AVR 30-day mortality by computing each score's observed-to-expected mortality ratio (O:E). Area under the receiver operating characteristic (ROC) curves tested discrimination, and the Hosmer-Lemeshow goodness-of-fit tested calibration. Among 941 patients (mean age, 72 ± 12 years), 6 deaths occurred within 30 days (actual mortality rate, 0.6%). All 4 scoring systems overpredicted expected mortality after mini-AVR: ACEF (1.4%), EuroSCORE II (1.9%), STS-PROM (2.0%), and TAVR-RS (2.1%). STS-PROM best estimated risk for patients with STS-PROM scores 0 to <1 (0.6 O:E), ACEF for patients with STS-PROM scores 2 to <3 (0.6 O:E), and TAVR-RS for patients with STS-PROM scores 3 to <4 (0.7 O:E). ROC curves showed only fair discrimination and calibration across all risk scores. In low-risk patients who underwent mini-AVR, current surgical scoring systems overpredicted mortality 2-to-3-fold. Alternative dedicated scoring systems for mini-AVR are needed for more accurate outcomes assessment.