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Gutierrez CS, Passos SC, Castro SMJ, Okabayashi LSM, Berto ML, Lorenzen MB, Caumo W, Stefani LC. Few and feasible preoperative variables can identify high-risk surgical patients: derivation and validation of the Ex-Care risk model. Br J Anaesth 2020; 126:525-532. [PMID: 33127046 DOI: 10.1016/j.bja.2020.09.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/06/2020] [Accepted: 09/10/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The development of feasible preoperative risk tools is desirable, especially for low-middle income countries with limited resources and complex surgical settings. This study aimed to derive and validate a preoperative risk model (Ex-Care model) for postoperative mortality and compare its performance with current risk tools. METHODS A multivariable logistic regression model predicting in-hospital mortality was developed using a large Brazilian surgical cohort. Patient and perioperative predictors were considered. Its performance was compared with the Charlson comorbidity index (CCI), Revised Cardiac Risk Index (RCRI), and the Surgical Outcome Risk Tool (SORT). RESULTS The derivation cohort included 16 618 patients. In-hospital death occurred in 465 patients (2.8%). Age, with adjusted splines, degree of procedure (major vs non-major), ASA physical status, and urgency were entered in a final model. It showed high discrimination with an area under the receiver operating characteristic curve (AUROC) of 0.926 (95% confidence interval [CI], 0.91-0.93). It had superior accuracy to the RCRI (AUROC, 0.90 vs 0.76; P<0.01) and similar to the CCI (0.90 vs 0.82; P=0.06) and SORT models (0.90 vs 0.92; P=0.2) in the temporal validation cohort of 1173 patients. Calibration was adequate in both development (Hosmer-Lemeshow, 9.26; P=0.41) and temporal validation cohorts (Hosmer-Lemeshow 5.29; P=0.71). CONCLUSIONS The Ex-Care risk model proved very efficient at identifying high-risk surgical patients. Although multicentre studies are needed, it should have particular value in low resource settings to better inform perioperative health policy and clinical decision-making.
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Affiliation(s)
- Claudia S Gutierrez
- Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Anaesthesia and Perioperative Medicine Service, Hospital de Clinicas de Porto Alegre, Brazil
| | - Sávio C Passos
- Anaesthesia and Perioperative Medicine Service, Hospital de Clinicas de Porto Alegre, Brazil
| | - Stela M J Castro
- Department of Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas S M Okabayashi
- Anaesthesia and Perioperative Medicine Service, Hospital de Clinicas de Porto Alegre, Brazil
| | - Mariana L Berto
- Anaesthesia and Perioperative Medicine Service, Hospital de Clinicas de Porto Alegre, Brazil
| | - Marina B Lorenzen
- Anaesthesia and Perioperative Medicine Service, Hospital de Clinicas de Porto Alegre, Brazil
| | - Wolnei Caumo
- Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Luciana C Stefani
- Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Anaesthesia and Perioperative Medicine Service, Hospital de Clinicas de Porto Alegre, Brazil; Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Correia JD, da Rosa EB, Silveira DB, Correia EPE, Lorenzen MB, Travi GM, Rosa RCM, Zen PRG, Zen TD, Rosa RFM. Trisomy 18 and eye anomalies. Am J Med Genet A 2016; 173:553-555. [PMID: 27792864 DOI: 10.1002/ajmg.a.38036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/07/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Jamile D Correia
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Ernani B da Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Daniélle B Silveira
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | | | - Giovanni M Travi
- Pediatric Ophthalmology, Hospital da Criança Santo Antônio (HCSA)/Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, RS, Brazil
| | - Rosana C M Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Paulo R G Zen
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Graduate Program in Biosciences, UFCSPA, Porto Alegre, RS, Brazil.,Clinical Genetics, UFCSPA and CHSCPA, Porto Alegre, RS, Brazil
| | - Tatiana D Zen
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Pharmacy, Faculdade de Ciências da Saúde, Centro Universitário Ritter dos Reis-UniRitter, Porto Alegre, RS, Brazil
| | - Rafael F M Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Graduate Program in Biosciences, UFCSPA, Porto Alegre, RS, Brazil.,Clinical Genetics, UFCSPA and CHSCPA, Porto Alegre, RS, Brazil
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Rosa RF, Rosa RC, Lorenzen MB, de Oliveira CA, Graziadio C, Zen PR, Paskulin GA. Trisomy 18: Frequency, types, and prognosis of congenital heart defects in a Brazilian cohort. Am J Med Genet A 2012; 158A:2358-61. [DOI: 10.1002/ajmg.a.35492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 04/18/2012] [Indexed: 11/11/2022]
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Rosa RF, Rosa RC, Lorenzen MB, de Moraes FN, Graziadio C, Zen PR, Paskulin GA. Trisomy 18: Experience of a reference hospital from the south of Brazil. Am J Med Genet A 2011; 155A:1529-35. [DOI: 10.1002/ajmg.a.34088] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 04/06/2011] [Indexed: 11/10/2022]
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Graziadio C, Lorenzen MB, Rosa RFM, Pinto LLC, Zen PRG, Travi GM, Valiatti F, Paskulin GA. New report of a familial case of Moebius syndrome presenting skeletal findings. Am J Med Genet A 2010; 152A:2134-8. [PMID: 20635408 DOI: 10.1002/ajmg.a.33548] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Carla Graziadio
- Clinical Genetics, Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, Brazil
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