{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T12:17:12Z","timestamp":1768911432541,"version":"3.49.0"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T00:00:00Z","timestamp":1700179200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>This study aimed to validate the accuracy of the Preoperative Pancreatic Resection (PREPARE) risk score in pancreatic resection patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and methods<\/jats:title><jats:p>This prospective study included 216 patients who underwent pancreatic resection between January 2015 and December 2018. All patients in our cohort with weight loss or lack of appetite received dietary advice and preoperative oral nutritional supplementation (600\u2005kcal\/day). Demographic, clinicopathological, operative, and postoperative data were collected prospectively. The PREPARE score and the predicted risk of major complications were computed for each patient. Differences in major postoperative complications were analyzed using a multivariate Cox proportional hazards regression model. The predicted and observed risks of major complications were tested using the C-statistic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study included 216 patients [117 men (54.2%)] with a median age of 65.0 (30.0\u201383.0) years. The majority of patients were classified as American Society of Anesthesiologists (ASA)\u2019 Physical Status score II (<jats:italic>N<\/jats:italic>\u2009=\u2009164\/216; 75.9%) and as \u201clow risk\u201d PREPARE score (<jats:italic>N<\/jats:italic>\u2009=\u2009185\/216; 85.6%) before the surgery. Only 4 (1.9%) patients were malnourished, with albumin levels of less than 3.5\u2005g\/dl. The most common type of pancreatic resection was a pylorus-preserving pancreaticoduodenectomy (<jats:italic>N<\/jats:italic>\u2009=\u2009122\/216; 56.5%). Major morbidity and 30-day mortality rates were 11.1% and 1.9%, respectively. The type of surgical procedure (hazard ratio [HR]: 3.849; 95% confidence interval [CI]: 1.208\u201312.264) and ASA score (HR: 3.089; 95% CI: 1.067\u20138.947) were significantly associated with the incidence of major postoperative complications in multivariate analysis. The receiver operating characteristic curve was 0.657 for incremental values and 0.559 for risk categories, indicating a weak predictive model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The results of the present study suggest that the PREPARE risk score has low accuracy in predicting the risk of major complications in patients with consistent preoperative nutritional support. This limits the use of PREPARE risk score in future preoperative clinical routines.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2023.1275432","type":"journal-article","created":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T11:18:44Z","timestamp":1700219924000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Preoperative nutritional support in patients undergoing pancreatic surgery affects PREPARE score accuracy"],"prefix":"10.3389","volume":"10","author":[{"given":"Pavel","family":"Skalicky","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katerina","family":"Knapkova","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jana","family":"Tesarikova","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michal","family":"Gregorik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dusan","family":"Klos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Lovecek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,11,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1093\/intqhc\/14.4.269","article-title":"Adverse events in surgical patients in Australia","volume":"14","author":"Kable","year":"2002","journal-title":"Int J Qual Health Care"},{"key":"B2","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1067\/msy.1999.98664","article-title":"The incidence and nature of surgical adverse events in Colorado and Utah in 1992","volume":"126","author":"Gawande","year":"1999","journal-title":"Surgery"},{"key":"B3","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1002\/bjs.5982","article-title":"Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy","volume":"95","author":"Balzano","year":"2008","journal-title":"Br J Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1097\/SLA.0b013e31821fd334","article-title":"Pancreatic cancer surgery in the new millennium: better prediction of outcome","volume":"254","author":"Hartwig","year":"2011","journal-title":"Ann Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1007\/s11605-011-1777-2","article-title":"Effect of surgeon volume on outcome following pancreaticoduodenectomy in a high-volume hospital","volume":"16","author":"Pecorelli","year":"2012","journal-title":"J Gastrointest Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"280","DOI":"10.5507\/bp.2016.011","article-title":"Long-term survival after resections for pancreatic ductal adenocarcinoma. 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