ValidaÃÃo de um escore preditivo de morbimortalidade cirÃrgica em pacientes superobesos submetidos à operaÃÃo de Fobi-Capella convencional / Validation of a predictive score of surgical morbidity and mortality in superobese patients submitted to Roux-en-Y gastric bypass
AUTOR(ES)
Euclides Dias Martins Filho
DATA DE PUBLICAÇÃO
2008
RESUMO
Introduction: Superobese patients who undergo gastroplasty have a greater incidence of complications. A high surgical risk results from the greater incidence of co-morbidity in this group, leading to the need for special care. By analyzing the risk factors identified in the pre-operative phase, giving them a grade, constructing a score and assessing the occurrence of serious complications and death, we will have elements to identify which patients are at greater risk. Objective: Determine the accuracy of the Recife score to predict serious post-operative complications and death in superobese patients who undergo conventional Fobi-Capella gastric bypass surgery. Casuistics and Methods: An ambidirectional study was conducted to validate the diagnostic test on 203 superobese patients submitted to Roux-en-Y Fobi-Capella gastric bypass at the Hospital das ClÃnicas at the Federal University of Pernambuco, from September 1997 to May 2007. The dependent variables were the serious postoperative complications and death. The independent variable was the Recife Score. Data was analyzed using the Epi-Ionfo 3.3 program. The analysis of the Recife scoreâs accuracy considered the following parameters: sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ration and negative likelihood ratio. Results: The accuracy of the Recife score with cutoff points higher than three and higher than five to predict serious postoperative complications was, respectively, a frequency of complications of 12.3%, with a risk ratio of 2.83 (CI 95%= 1.02 â 7.82), sensitivity of 57.1% and specificity of 69.8%, and 12.5%, with a risk ratio of 1.88 (CI 95% = 0.28 â 12.62), sensitivity of 7.1% and specificity of 96.3%. The accuracy of the Recife score with cutoff points higher than three and higher than five to predict death was, respectively, a frequency of death of 7.7%, with a risk ratio of 10.62 (CI 95%= 1.27 â 88.04., sensitivity of 83.3% and specificity of 69.5%, and 12.5%, with a risk ratio of 4.88 (CI 95%= = 0.64 â 37.02), sensitivity of 16.7% and specificity of 96.5%. Conclusion: Superobese patients who have a score >3 in the Recife score during the preoperative phase of conventional gastroplasty have high accuracy for the prediction of serious postoperative complications and death.
ASSUNTO(S)
postoperative complications cirurgia superobesity obesidade mÃrbida complicaÃÃes pÃs-operatÃrias recife score risk factors escore do recife superobeso fatores de risco severe obesity
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