Operative Risk Assessment
A number of factors go into the ‘risk’ associated with undergoing surgery.
These include, but are not limited to:
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
The most common systems of note are
Other useful scoring systems include:
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
- Specific biomarkers
Risk scoring systems
The most common systems of note are
- ASA grade
- P-POSSUM
Other useful scoring systems include:
- SORT
- Nottingham hip fracture score
- Lee’s revised cardiac risk index
- Performance status
ASA Grade
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 full description of each grade, with example, is available from the ASA site:
https://www.asahq.org/resources/clinical-information/asa-physical-status-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
- Brain dead
A full description of each grade, with example, is available from the ASA site:
https://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system
P-POSSUM
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.
A calculator is available online here:
http://www.riskprediction.org.uk/index-pp.php
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.
A calculator is available online here:
http://www.riskprediction.org.uk/index-pp.php
SORT
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
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
Links & References
- American Society of Anesthesiologists. ASA physical status classification system. 2014. Available at: https://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system
- Smith, J. Risk prediction in surgery. Available at: http://www.riskprediction.org.uk/
- University College London. Perioperative Medicine Masters Programme. 2017
- NCEPOD. SORT. Available at: http://www.sortsurgery.com/SORT_home
- National Emergency Laparotomy Audit. http://www.nela.org.uk/
