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

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

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.

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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

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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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Authors and Affiliations

  1. Department of General Surgery, Princess Royal University Hospital, Farnborough, Bromley Kent, BR6 8ND, UK

    Aninda Chandra

  2. Department of Colorectal Surgery, Queen Elizabeth Queen Mother Hospital, Margate, Kent, CT4 9AN, UK

    Sudhakar Mangam & Deya Marzouk

  3. 106 Denham Lane, Chalfont St. Peter, near GX, Buckinghamshire, SL9 0QJ, UK

    Aninda Chandra

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  1. Aninda Chandra
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Correspondence to Aninda Chandra.

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The authors declare that they have no competing interests.

Authors’ Contributions

AC devised and wrote the preliminary draft. AC and SM performed the literature search and revised the article. DM supervised the project and wrote the introduction.

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Chandra, A., Mangam, S. & Marzouk, D. A Review of Risk Scoring Systems Utilised in Patients Undergoing Gastrointestinal Surgery. J Gastrointest Surg 13, 1529–1538 (2009). https://doi.org/10.1007/s11605-009-0857-z

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