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Journal of Gastrointestinal Surgery

, Volume 13, Issue 8, pp 1529–1538 | Cite as

A Review of Risk Scoring Systems Utilised in Patients Undergoing Gastrointestinal Surgery

  • Aninda Chandra
  • Sudhakar Mangam
  • Deya Marzouk
Review Article

Abstract

Introduction

Adequate stratification and scoring of risk is essential to optimise clinical practice; the ability to predict operative mortality and morbidity is important. This review aims to outline the essential elements of available risk scoring systems in patients undergoing gastrointestinal surgery and their differences in order to enable effective utilisation.

Methods

The English literature was searched over the last 50 years to provide an overview of systems pertaining to the adult surgical patient.

Discussion

Scoring systems can provide objectivity and mortality prediction enabling communication and understanding of severity of illness. Incorporating subjective factors within scoring systems can allow clinicians to apply their experience and understanding of the situation to an individual but are not reproducible. Limitations relating to obtaining variables, calculating predicted mortality and applicability were present in most systems. Over time scoring systems have become out-dated which may reflect continuing improvement in care. APACHE II shows the importance of reproducibility and comparability particularly when assessing critically ill patients. Both NSQIP in the USA and P-POSSUM in the UK seem to have many benefits which derive from their comprehensive dataset. The “Surgical Apgar” score offers relatively objective criteria which contrasts against the subjective nature of the ASA score.

Conclusion

P-POSSUM and NSQIP are comprehensive but are difficult to calculate. In the search for a simple and easy to calculate score, the “Surgical Apgar” score may be a potential answer. However, more studies need to be performed before it becomes as widely taken up as APACHE II, NSQIP and P-POSSUM.

Keywords

Critical illness Critical care Surgery Risk assessment Peri-operative care Prognosis High dependency unit Scoring systems 

Abbreviations

APACHE

Acute Physiology and Chronic Health Evaluation

ASA

American Society of Anaesthesiologists

AVPU

Alert/Voice/Pain/Unresponsive (conscious level)

BUPA

British United Provident Association

CRIA

Cardiac Risk Index Assessment

ICU

Intensive Care Unit

E-PASS

Estimation of Physiologic Ability and Stress

GCS

Glasgow Coma Scale

HDU

High Dependency Unit

ICNARC

Intensive Care National Audit and Research Centre

Max-Fax

Maxillary Facial

MPM

Mortality Prediction Model

NSQIP

National Surgical Quality Improvement Programme

Op

Operation

POSSUM

Physiological and Operative Severity Score for EnUmeration of Mortality and Morbidity

P-POSSUM

Portsmouth POSSUM

SMS

Surgical Mortality Score

SRS

Surgical Risk Score

SAPS

Simplified Acute Physiology Score

SaO2

Arterial Oxygen Saturations

Notes

Acknowledgements

Special thanks to Dr Jules Barwell, Senior Lecturer and Honorary Consultant in Genetics, Leicester and Dr Barry Phillips, Consultant Intensivist, Eastbourne for their support and suggestions having reviewed the paper.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • Aninda Chandra
    • 1
    • 3
  • Sudhakar Mangam
    • 2
  • Deya Marzouk
    • 2
  1. 1.Department of General SurgeryPrincess Royal University HospitalFarnboroughUK
  2. 2.Department of Colorectal SurgeryQueen Elizabeth Queen Mother HospitalMargateUK
  3. 3.BuckinghamshireUK

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