O sistema Apache II e o prognóstico de pacientes submetidos às operações de grande e pequeno porte / Apache II scores and prognosis for patients submitted to major and minor surgeries

RESUMO

OBJETIVO: Geral avaliar o desempenho do sistema APACHE II no pré-operatório de operações de grande e pequeno porte como indicador prognóstico. Os objetivos secundários são (a) avaliar o sistema no pré-operatório para predizer morbidade; (b) comparar resultados entre os dois grupos e; (c) comparar a mortalidade observada com a esperada, calculada pela Equação de Knaus. MÉTODO: Estudo de coorte prospectivo, por 30 meses. No Grupo 1, correspondente à operação de pequeno porte, incluídos 30 pacientes submetidos a herniorrafia inguinal. No Grupo 2, correspondente à operação de grande porte, incluídos 50 casos, sendo 20 submetidos à esofagectomia, 20 à gastrectomia e 10 à duodenopancreatectomia cefálica. RESULTADOS: A média do APACHE II no Grupo 1 foi de 2,5 pontos (0 a 8 pontos).No Grupo 2 teve média de 3,9 pontos (0 a 12 pontos). A morbidez tanto geral quando calculada de acordo com índice de pontos baixo, moderado e alto, apresentaram significância na comparação de ambos grupos pelo teste quiquadrado (p<0,00001). A mortalidade geral e o índice alto de pontos, no cálculo quiquadrado corrigido Yates, apresentaram diferença entre os grupos (p<0,001 e p<0,0005). Estratificada a mortalidade por classe de pontos, esta não foi diferente nas classes de baixa e moderada pontuação. CONCLUSÕES: O sistema demonstrou tendência para predizer desfecho a pacientes submetidos à operação de grande porte. Pacientes apresentando, no pré-operatório de operações de grande porte, APACHE II acima de oito apresentam índice elevado de morbidez e mortalidade.

ABSTRACT

BACKGROUND: The general objective of this work was to compare APACHE II scores referent to prognostic in the preoperative period of major and minor surgeries. Specific objectives included (1) the evaluation of the ability of APACHE II to predict morbidity in the preoperative period; (2) the comparison of the results of both types of surgery; and (3) the comparison of the mortality rates observed and expected according to the Knaus Equation. METHODS: This was a prospective cohort study, performed in 30 months. Group 1 included 30 patients, submitted to inguinal herniorraphy, representing minor surgery. Fifty cases were included in group 2, representing major surgery 20 were submitted to esophagectomy, 20 to gastrectomy and 10 underwent cephalic duodenopancreatectomy. RESULTS: The average preoperative score of patients in group 1 was 2.5 points (range 0 to 8 points). The APACHE II score of group 2 was in average 3.9 points, ranging from zero to 12 points (standard deviation 2.8 points). The morbidity of the two groups, in general or as evaluated according to low, moderate or high scores, was significantly different when compared by the chi-square test (p<0.00001). General mortality and high scores, as evaluated by the Yates-corrected chi-square test, were different between the two groups (p<0.001 and p<0.0005). When the mortality rate was classified according to the score of points, no statistically significant differences were observed between low and moderate scores. CONCLUSION: The APACHE II score, when applied during the preoperative period. showed the power to predict the outcome of patients submitted to major surgeries. High morbidity and mortality rates are associated to patients presenting APACHE II scores higher than eight, particularly if submitted to major surgery.