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Identification of the high risk emergency surgical patient: Which risk prediction model should be used?

Stonelake S, Thomson P, Suggett N - Ann Med Surg (Lond) (2015)

Bottom Line: Morbidity risk scores were calculated using the POSSUM predicted morbidity and compared against actual morbidity according to the Clavien-Dindo classification.Patients having a POSSUM morbidity risk of greater than 50% developed significantly more life-threatening complications (CD 4-5) compared with those who predicted less than or equal to 50% morbidity risk (P = 0.01).Post-operative risk scoring using the CR-POSSUM is more accurate and we suggest can be used to identify patients who require intensive care post-operatively.

View Article: PubMed Central - PubMed

Affiliation: Sandwell General Hospital, Lyndon, West Bromwich, West Midlands, B71 4HJ, UK.

ABSTRACT

Introduction: National guidance states that all patients having emergency surgery should have a mortality risk assessment calculated on admission so that the 'high risk' patient can receive the appropriate seniority and level of care. We aimed to assess if peri-operative risk scoring tools could accurately calculate mortality and morbidity risk.

Methods: Mortality risk scores for 86 consecutive emergency laparotomies, were calculated using pre-operative (ASA, Lee index) and post-operative (POSSUM, P-POSSUM and CR-POSSUM) risk calculation tools. Morbidity risk scores were calculated using the POSSUM predicted morbidity and compared against actual morbidity according to the Clavien-Dindo classification.

Results: The actual mortality was 10.5%. The average predicted risk scores for all laparotomies were: ASA 26.5%, Lee Index 2.5%, POSSUM 29.5%, P-POSSUM 18.5%, CR-POSSUM 10.5%. Complications occurred following 67 laparotomies (78%). The majority (51%) of complications were classified as Clavien-Dindo grade 2-3 (non-life-threatening). Patients having a POSSUM morbidity risk of greater than 50% developed significantly more life-threatening complications (CD 4-5) compared with those who predicted less than or equal to 50% morbidity risk (P = 0.01).

Discussion: Pre-operative risk stratification remains a challenge because the Lee Index under-predicts and ASA over-predicts mortality risk. Post-operative risk scoring using the CR-POSSUM is more accurate and we suggest can be used to identify patients who require intensive care post-operatively.

Conclusions: In the absence of accurate risk scoring tools that can be used on admission to hospital it is not possible to reliably audit the achievement of national standards of care for the 'high-risk' patient.

No MeSH data available.


Related in: MedlinePlus

Inclusion and exclusion criteria.
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fig1: Inclusion and exclusion criteria.

Mentions: We performed a retrospective analysis of 108 consecutive emergency laparotomies between January 2012 and July 2012. Laparotomies were performed at the University Hospital Birmingham, a tertiary referral hospital which also provides an acute general surgical service to its local population in Birmingham. Inclusion and exclusion criteria are listed in Fig. 1 and were taken from the National Emergency Laparotomy Audit (NELA). Post-operative morbidity was recorded until the time of discharge or death. 22 cases were excluded due to incomplete data, leaving 86 laparotomy cases in the study population.


Identification of the high risk emergency surgical patient: Which risk prediction model should be used?

Stonelake S, Thomson P, Suggett N - Ann Med Surg (Lond) (2015)

Inclusion and exclusion criteria.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4543083&req=5

fig1: Inclusion and exclusion criteria.
Mentions: We performed a retrospective analysis of 108 consecutive emergency laparotomies between January 2012 and July 2012. Laparotomies were performed at the University Hospital Birmingham, a tertiary referral hospital which also provides an acute general surgical service to its local population in Birmingham. Inclusion and exclusion criteria are listed in Fig. 1 and were taken from the National Emergency Laparotomy Audit (NELA). Post-operative morbidity was recorded until the time of discharge or death. 22 cases were excluded due to incomplete data, leaving 86 laparotomy cases in the study population.

Bottom Line: Morbidity risk scores were calculated using the POSSUM predicted morbidity and compared against actual morbidity according to the Clavien-Dindo classification.Patients having a POSSUM morbidity risk of greater than 50% developed significantly more life-threatening complications (CD 4-5) compared with those who predicted less than or equal to 50% morbidity risk (P = 0.01).Post-operative risk scoring using the CR-POSSUM is more accurate and we suggest can be used to identify patients who require intensive care post-operatively.

View Article: PubMed Central - PubMed

Affiliation: Sandwell General Hospital, Lyndon, West Bromwich, West Midlands, B71 4HJ, UK.

ABSTRACT

Introduction: National guidance states that all patients having emergency surgery should have a mortality risk assessment calculated on admission so that the 'high risk' patient can receive the appropriate seniority and level of care. We aimed to assess if peri-operative risk scoring tools could accurately calculate mortality and morbidity risk.

Methods: Mortality risk scores for 86 consecutive emergency laparotomies, were calculated using pre-operative (ASA, Lee index) and post-operative (POSSUM, P-POSSUM and CR-POSSUM) risk calculation tools. Morbidity risk scores were calculated using the POSSUM predicted morbidity and compared against actual morbidity according to the Clavien-Dindo classification.

Results: The actual mortality was 10.5%. The average predicted risk scores for all laparotomies were: ASA 26.5%, Lee Index 2.5%, POSSUM 29.5%, P-POSSUM 18.5%, CR-POSSUM 10.5%. Complications occurred following 67 laparotomies (78%). The majority (51%) of complications were classified as Clavien-Dindo grade 2-3 (non-life-threatening). Patients having a POSSUM morbidity risk of greater than 50% developed significantly more life-threatening complications (CD 4-5) compared with those who predicted less than or equal to 50% morbidity risk (P = 0.01).

Discussion: Pre-operative risk stratification remains a challenge because the Lee Index under-predicts and ASA over-predicts mortality risk. Post-operative risk scoring using the CR-POSSUM is more accurate and we suggest can be used to identify patients who require intensive care post-operatively.

Conclusions: In the absence of accurate risk scoring tools that can be used on admission to hospital it is not possible to reliably audit the achievement of national standards of care for the 'high-risk' patient.

No MeSH data available.


Related in: MedlinePlus