A number of factors go into the ‘risk’ associated with undergoing surgery. These include, but are not limited to:
The type of surgery
The acuity of surgery
The patient’s medical comorbidities
Risk Assessment Tools
Several tools can be used to help guide the assessment of risk for patients undergoing surgery. The overall risk picture is clearly more complex than can be assessed by simple numerical tools, but they can be very useful support in the assessment process.
Such tools can generally be divided into 3 main categories:
Risk scoring systems
Functional assessment tools
Risk scoring systems The most common systems of note are
Other useful scoring systems include:
Nottingham hip fracture score
Lee’s revised cardiac risk index
The American Society of Anesthesiology physical status score is a well known, general classification system. It provides a general assessment of risk based on the baseline heath of the patient.
There are 6 grades:
A normal healthy patient
Mild systemic disease
Severe systemic disease
Severe systemic disease that is a constant threat to life
A moribund patient, not expected to survive without the operation
The Physiological and Operative Severity Score for the enumeration of Morbidity and Mortality (POSSUM) score was the initial format of this score, developed in 1991. It was based on a retrospective analysis of a large patient cohort to identify which factors contributed to a poor outcome (30 day morbidity and mortality). This was modified by a team in Portsmouth to create the P-POSSUM score. This is best used as an online tool that provides an estimate of the patient’s morbidity and mortality, based on their specific medical and physiological parameters.
The Surgical Outcome Risk Tool was derived following the NCEPOD report “Knowing the risk”. This report highlighted the importance of being able to identify high risk patients preoperatively. As such the SORT score was derived from a large population and internally validated. This uses 6 main risk factors to provide an estimated risk for the patient.
An online calculator is available here: http://www.sortsurgery.com/SORT_home