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European Geriatric Medicine

, Volume 9, Issue 1, pp 51–59 | Cite as

Addition of clinical risk scores improves prediction performance of American Society of Anesthesiologists (ASA) physical status classification for postoperative mortality in older patients: a pilot study

  • Danica MarkovicEmail author
  • Tatjana Jevtovic-Stoimenov
  • Milena Stojanovic
  • Anita Vukovic
  • Vesna Dinic
  • Bojana Markovic-Zivkovic
  • Radmilo J. Jankovic
Research Paper

Abstract

Purpose

Many methods for preoperative risk stratifications used in everyday practice do not take into account all of the comorbidities and complex physiological status of older patients. Therefore, anaesthesiologists and surgeons must consider multiple ways of preoperative diagnostics. Determining which of the preoperative clinical risk scores [Revised Lee score, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator and Surgical Outcome Risk Tool (SORT)] best improves routinely used American Society of Anaesthesiologists (ASA) physical status classification.

Methods

The prospective pilot study included 78 patients who were being prepared for extensive non-cardiac surgeries under general anaesthesia. Preoperatively, anaesthesiologist determined ASA score according to guidelines. Then, the data of patients have been processed on the interactive calculators of Revised Lee score, ACS NSQIP and SORT.

Results

Mean age of included patients was 71.4 ± 6.9 years. When it comes to postoperative mortality prediction, three risk scores (ASA, ACS NSQIP and SORT) have been statistically significant, respectively, P = 0.016, P < 0.0001, P < 0.0001. Results showed that AUC being higher in ACS NSQIP and SORT (0.813; 0.797). Out of all three additional risk scores, ACS NSQIP showed to add the most to the specificity and sensitivity of ASA score, with combined AUC = 0.841.

Conclusions

ACS NSQIP and SORT increase the accuracy of ASA score. Revised Lee score cannot be considered a good indicator of postoperative mortality risk since it is primarily the score which indicates risk for cardiovascular complications. Further studies, with a greater number of patients, are needed.

Keywords

Care Preoperative Mortality In Hospital ACS-NSQIP ASA SORT 

Notes

Acknowledgements

We would like to thank Miodrag Krstić, Master Engineer of Electrical Engineering and Computer Science, for his assistance in statistical analyses of data.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© European Geriatric Medicine Society 2017

Authors and Affiliations

  1. 1.General Surgery Clinic, Center for Anestesiology and ReanimatologyClinical Center of NišNisSerbia
  2. 2.Department for Biochemistry, Medical SchoolUniversity of NišNisSerbia
  3. 3.Medical SchoolUniversity of NisNisSerbia
  4. 4.Medical High School ‘Dr. Milenko Hadžić’NisSerbia
  5. 5.Department for Emergency Medicine, Medical SchoolUniversity of NišNisSerbia

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