Individualised risk scoring in elective colorectal surgery: Why don’t we do it?

Abstract

Background: National guidelines recommend that all patients having major elective surgery should have a risk estimate communicated to them.1 Several well validated Individualised Risk Scores (IRS) are available to facilitate this.2 Not all patients seem to receive a personalised risk assessment when having elective colorectal surgery. The aim of this study was to investigate the reasons behind this. Methods: An electronic survey was circulated to all general surgeons and anaesthetists (trainees and consultants) at Leeds Teaching Hospitals NHS Trust. Participants had 1 month to respond and received a reminder email at 3 weeks. Ethical approval for this study was gained from the University of Leeds Medical Research Ethics Committee (MREC21-073). Results: There were 43 respondents, 33 of whom assess patients for elective colorectal surgery. Seven were surgeons and 26 were anaesthetists; 80% were consultants. Whereas 66% provide an overall estimate of risk to patients, only 55% use IRSs (Fig. 5). Preferred IRS included SORT, P-POSSUM, ACS NSQIP (Surgical Outcome Risk Tool, Portsmouth - Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity, American College of Surgeons National Surgical Quality Improvement Program, National Emergency Laparotomy Audit) risk calculator, NELA risk calculator and the ASA physical status classification system. Conclusion: Half of respondents do not use IRS. The tools used are heterogeneous and not necessarily validated for this population and context. Clarity is needed regarding which tools to use in this population and what information to present to patients. An improved understanding of clinicians’ perceptions of IRS is required to design appropriate implementation solutions.