The TOPHAN Score for Predicting Postoperative Intensive Care Unit Admission in Gynecologic Oncology Patients: A Cohort Study
Tofan Widya Utami, Gatot Purwoto, Kade Yudi Saspriyana, Arisda Oktalia, Riyadh Firdaus, Aria Kekalih, Eva SuarthanaAbstract
Background:
Surgical procedures are the gold standard for managing gynecologic cancer, with intensive care playing a crucial postoperative role. However, intensive care unit (ICU) availability in low- and middle-income countries is severely limited. This study aimed to develop a reliable preoperative scoring system to predict postoperative ICU needs in gynecologic oncologycases.
Materials and Methods:
Model development was conducted using a retrospective cohort from January 2013 to December 2019. Data from gynecologic oncology patients included clinical characteristics, lab values, intraoperative bleeding, and surgical duration. Variables with
Results:
Among 843 surgeries, 380 (45.07%) required ICU admission. Significant predictors included age, hemoglobin, American Society of Anesthesiologists status, surgical access, estimated blood loss, duration, and tumor site. These variables consequently construct the proposed TOPHAN (T = Time of surgery duration; O = Organ site; P = Procedure access; H = Hemoglobin; A = Age/ASA; and N = depletioN of blood volume.) score. A 26.5 cutoff showed 75.8% sensitivity and 64.6% specificity. Temporal validation showed that a 20.5 cutoff improved alignment (76.5% sensitivity and 73.8% specificity).
Conclusion:
TOPHAN score represents a preliminary preoperative tool for predicting postoperative ICU admission in gynecologic oncology surgery. Temporal validation suggests that scores above 20.5 are associated with a higher likelihood of ICU requirement. Furthermore, multicenter studies are warranted to enhance its generalizability and refine its clinical application.