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
- 86 Downloads
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.
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.
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.
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.
KeywordsCare Preoperative Mortality In Hospital ACS-NSQIP ASA SORT
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.
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 was obtained from all individual participants included in the study.
- 1.The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA) (2014) 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management. Eur Heart J 35:2383–2431CrossRefGoogle Scholar
- 13.Markovic D, Jevtovic-Stoimenov T, Cosic V, Stosic B, Markovic-Zivkovic B, Jankovic RJ. Addition of biomarker panel improves prediction performance of American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator for cardiac risk assessment of elderly patients preparing for major non-cardiac surgery: a pilot study. Aging Clin Exp Res (Article in print) Google Scholar
- 30.Harris C, Kim S, Groban L (2015) How well does the NSQIP surgical calculator predict early adverse outcomes in plder non-cardiac surgical patients with self-reported limitations in mobility? Gerontologist 55:192Google Scholar
- 36.Basta MN, Bauder AR, Kovach S, Fischer JP (2016) Assessing the predictive accuracy of the ACS NSQIP surgical risk calculator in open ventral hernia repair. Plast Reconstr Surg Glob Open 4:p115Google Scholar
- 39.Chung PJ, Carter TI, Burack JH, Tam S, Alfonso A, Sugiyama G (2015) Predicting the risk of death following coronary artery bypass graft made simple: a retrospective study using the American College of Surgeons National Surgical Quality Improvement Program database. J Cardiothorac Surg 10:62CrossRefPubMedPubMedCentralGoogle Scholar
- 43.Wozniak SE, Coleman JA, Katlic MR (2016) Preoperative evaluation of the older patient. J Perioper Crit Intensive Care Nurs 2:1Google Scholar
- 45.Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF (2012) Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg 215(4):453–466CrossRefPubMedGoogle Scholar