Designing a new scoring system (QualyP Score) correlating the management of cardiopulmonary bypass to postoperative outcomes

Aim:

The aim of this study was to ascertain if a score, directly derived from CPB records, could correlate to major postoperative outcomes.

Methods:

An additive score (QualyP Score) was created from 10 parameters: peak lactate value during CPB, peak VCO2i, lowest DO2i/VCO2i, peak respiratory quotient, CPB time, cross-clamp time, lowest CPB temperature, circulatory arrest, ultrafiltration during CPB, number of packed red cells transfused intraoperatively. The PerfSCORE was calculated, as well. Multivariable logistic regression models were built to detect the independent predictors of: peak lactate >3 mmol/L during the first three postoperative days; the incidence of acute kidney injury network (AKIN) 1-2-3; respiratory insufficiency; mortality.

Results:

The mean score was 4.8±2.6 (0-10). A QualyP Score ≥1 was predictive of postoperative acidosis (OR=1.595). A score ≥2 was predictive of AKIN 2 (OR=1.268) and respiratory insufficiency (OR=1.526). A score ≥5 was predictive of AKIN 3 (OR=1.848) and mortality (OR=1.497).

Conclusions:

QualyP Score may help to provide a quality marker of perfusion, emphasizing the need for goal-directed perfusion strategies.

[Technic for repair of laparoceles by an extraperitoneal approach]

The authors report their experience with a technique for reconstruction of the abdominal wall, without opening the peritoneal sac, in patients with ventral hernia. After detailing the basic principles and advantages of the technique, they conclude by stating that it constitutes an effective procedure for repair of ventral hernias of the median line without endoabdominal morbid associations.

[Retroperitoneal tumors in children: clinical diagnostic problems (author's transl)]

Starting from two recent observations of retroperitoneal tumors in the pediatric age group (a nephroblastoma and a ganglioneuroma), the authors illustrate the main characteristics of these malignancies and emphasize the difficulties often encountered in differential diagnosis.