title: Prediction of severe complications and death in superobese patients undergoing open gastric bypass with the Recife Score.
abstract: BACKGROUND
  Superobese patients who undergo gastric bypass have a greater incidence of complications. The greater incidence of comorbidity in this group leads to a higher surgical risk, and a need for special care. By analyzing the risk factors identified in the preoperative period, scoring them, 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
  To determine the accuracy of the Recife Score for predicting serious postoperative complications and death in superobese patients who undergo Roux-en-Y gastric bypass surgery by the conventional method.
  
  
  METHODS
  An ambidirectional study was conducted to validate the diagnostic test on 203 severely obese patients submitted to Roux-en-Y gastric bypass at the Hospital das Clínicas of the Federal University of Pernambuco, Recife, PE, Brazil, from September 1997 to May 2007. The dependent variables were major postoperative complications and death. The independent variable was the Recife Score. The data were analyzed using the Epi-Info 3.5.1 program. The accuracy of the Recife Score was analyzed considering the following parameters: sensitivity, specificity, positive predictive value, negative predictive value, positive verisimilitude ratio and negative verisimilitude ratio.
  
  
  RESULTS
  The accuracy of the Recife Score with cut-off points higher than 3 and higher than 5 to predict serious postoperative complications was, respectively, a frequency of complications of 12.3%, with a risk ratio of 2.83, sensitivity of 57.1% and specificity of 69.8%, and 12.5%, with a risk ratio of 1.88, sensitivity of 7.1% and specificity of 96.3%. The accuracy of the Recife Score with cut-off points higher than 3 and higher than 5 to predict death was, respectively, a frequency of death of 7.7%, with a risk ratio of 10.62, sensitivity of 83.3% and specificity of 69.5%, and 12.5%, with a risk ratio of 4.88, sensitivity of 16.7% and specificity of 96.5%.
  
  
  CONCLUSIONS
  A Recife Score >3 prior to conventional gastric bypass presents a high level of accuracy in the prediction of serious postoperative complications and death.
authors.affiliation: Bariatric Surgery Unit of the General Surgery Division of the University Hospital of The Federal University of Pernambuco (UFPE), Recife, PE, Brasil. euclides_martins@yahoo.com.br
authors.forename: Euclides Dias
authors.initials: ED
authors.lastname: Martins-Filho
authors.forename: Leila
authors.initials: L
authors.lastname: Katz
authors.forename: Melania
authors.initials: M
authors.lastname: Amorim
authors.forename: Alvaro Antônio Bandeira
authors.initials: AA
authors.lastname: Ferraz
authors.forename: Edmundo Machado
authors.initials: EM
authors.lastname: Ferraz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000401:mortality* / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D012307:Risk Factors; D055815:Young Adult