Introduction/Background*Increase in the incidence of gynaecological cancers has resulted in increased operative procedures, specifically in patients with multiple comorbidities including obesity and frailty. This is often associated with prolonged admission and higher rates of postoperative mortality and morbidity and presents a challenge with an unmet need for an accurate, personalised risk prediction. Duke Activity Scale Index (DASI) is a 12 item scale in the form of self-reported questionnaire based around commonly performed activities of daily living. Currently, DASI is used to evaluate patients with cardiovascular diseases, however there is growing interest in utilising it in preoperative setting in different specialities. This study investigates the accuracy of DASI in preoperative prediction of postoperative outcomes in gynaeoncology.
Methodology A retrospective cohort study of 486 patients who had undergone an operative treatment at a tertiary oncology centre. Data collection undertaken through dedicated gynaeoncology database and missing data collected through patients’ records. All patients had completed the DASI questionnaire prior to their consultation. Actual postoperative 30 day complications and the length of stay also recorded. DASI was then compared with the occurrence of postoperative complications.
Result(s)*242 patients had a Da Vinci robot-assisted procedure, 44 - laparoscopic and 200 - open surgery. 133/486 were classified as having any type of complications within 30 days of the operation. Our results have shown that the higher DASI score the less likely patients were to have postoperative complications. This result was statistically significant with odds ratio of 0.973 and confidence interval between 0.961 and 0.986. We were also able to demonstrate that for every 10 points further up the DASI score a patient was 0.761 times less likely to have a postoperative complication. Hence general morbidity prediction of DASI score has been found to statistically significantly predict postoperative complications (AUC-0.740).
Conclusion*Our study has shown that DASI self-reported score is a useful predictive tool of perioperative estimation of postoperative complications in the gynaeoncology setting. Further analysis with a larger sample size and a multicentre prospective study is currently underway to validate the findings.
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