title: Preoperative Pancreatic Resection (PREPARE) score: a prospective multicenter-based morbidity risk score.
abstract: OBJECTIVE
  Development of a simple preoperative risk score to predict morbidity related to pancreatic surgery.
  
  
  BACKGROUND
  Pancreatic surgery is standardized with little technical diversity among institutions and unchanging morbidity and mortality rates in recent years. Preoperative identification of high-risk patients is potentially one of the rare avenues for improving the clinical course of patients undergoing pancreatic surgery.
  
  
  METHODS
  Using a prospectively collected multicenter database of patients undergoing pancreatic surgery (n=703), surgical complications were classified according to the Clavien-Dindo classification. A new scoring system for preoperative identification of high-risk patients that included only objective preoperatively assessable variables was developed using a multivariate regression model. Subsequently, this scoring system was prospectively validated from 2011 to 2013 (n=429) in a multicenter setting.
  
  
  RESULTS
  Eight independent preoperatively assessable variables were identified and included in the scoring system: systolic blood pressure, heart rate, hemoglobin level, albumin level, ASA (American Society of Anesthesiologists) score, surgical procedure, elective surgery or not, and disease of pancreatic origin or not. On the basis of 3 subgroups (low risk, intermediate risk, high risk), the proposed scoring system reached an accuracy of 75% for correctly predicting occurrence or nonoccurrence of major surgical complications in 80% of all analyzed patients within the validation cohort (c-statistic index=0.709, P<0.001, 95% confidence interval=0.657-0.760).
  
  
  CONCLUSIONS
  We present an easily applied scoring system with convincing accuracy for identifying low-risk and high-risk patients. In contrast to other systems, the score is exclusively based on objective preoperatively assessable characteristics and can be rapidly and easily calculated.
authors.affiliation: *Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany †Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany ‡Department of Surgery, St. Josef-Hospital Bochum, Hospital of the Ruhr-University, Bochum, Germany §Department of General Surgery, University of Milan, Instituto Clinico Humanitas IRCCS, Milan, Italy ¶Department of Surgery, Unit of Surgery B, The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy.
authors.forename: Faik G
authors.initials: FG
authors.lastname: Uzunoglu
authors.forename: Matthias
authors.initials: M
authors.lastname: Reeh
authors.forename: Eik
authors.initials: E
authors.lastname: Vettorazzi
authors.forename: Till
authors.initials: T
authors.lastname: Ruschke
authors.forename: Philipp
authors.initials: P
authors.lastname: Hannah
authors.forename: Michael F
authors.initials: MF
authors.lastname: Nentwich
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Vashist
authors.forename: Dean
authors.initials: D
authors.lastname: Bogoevski
authors.forename: Alexandra
authors.initials: A
authors.lastname: König
authors.forename: Monika
authors.initials: M
authors.lastname: Janot
authors.forename: Francesca
authors.initials: F
authors.lastname: Gavazzi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zerbi
authors.forename: Valentina
authors.initials: V
authors.lastname: Todaro
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Malleo
authors.forename: Waldemar
authors.initials: W
authors.lastname: Uhl
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
authors.forename: Maximilian
authors.initials: M
authors.lastname: Bockhorn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007430:Intraoperative Care; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D016896:Treatment Outcome