New surgical scoring system to predict postoperative mortality

Maho Kinoshita,Makoto Ozaki,Mariko Yabuuchi,Nobutada Morioka

doi:10.1007/s00540-016-2290-2

Abstract

PurposeThere is still no easy and highly useful method to comprehensively assess both preoperative and intraoperative patient statuses to predict postoperative outcomes. We attempted to develop a new scoring system that would enable a comprehensive assessment of preoperative and intraoperative patient statuses instantly at the end of anesthesia, predicting postoperative mortality.MethodsThe study included 32,555 patients who underwent surgery under general or regional anesthesia from 2008 to 2012. From the anesthesia records, extracted factors, including patient characteristics and American Society of Anesthesiologists physical status classification (ASA-PS), and three intraoperative indexes (the lowest heart rate, lowest mean arterial pressure, and estimated volume of blood loss) are used to calculate the surgical Apgar score (sAs). The sAs and ASA-PS, and surgical Apgar score combined with American Society of Anesthesiologists physical status classification (SASA), which combines the sAs and ASA-PS into a single adjusted scale, were compared and analyzed with postoperative 30-day mortality.ResultsIncreased severity of the sAs, ASA-PS and SASA was correlated with significantly higher mortality. The risk of death was elevated by 3.65 for every 2-point decrease in the sAs, by 6.4 for every 1-point increase in the ASA-PS, and by 9.56 for every 4-point decrease in the SASA. The ROC curves of the sAs and ASA-PS alone also individually demonstrated high validity (AUC = 0.81 for sAs and 0.79 for ASA-PS, P < 0.001). The SASA was even more valid (AUC = 0.87, P < 0.001).ConclusionsThe sAs and ASA-PS were shown to be extremely useful for predicting 30-day mortality after surgery. An even higher predictive ability was demonstrated by the SASA, which combines these simple and effective scoring systems.

Highlights

In recent years, with advances in the fields associated with anesthesia, surgery has become increasingly applicable to a wider range of diseases and patients, and the annual number of operations performed is increasing globally [1]
None of the 3 scoring systems were associated with age, sex, body mass index (BMI), surgical specialties, operative duration, or anesthesia duration
The rate of emergency surgery increased as severity increased, with lower surgical Apgar score (sAs), with higher American Society of Anesthesiologists physical status classification (ASA-PS) and with lower SASA: it was not significant (Tables 2, 3, 4)

Summary

Introduction

With advances in the fields associated with anesthesia, surgery has become increasingly applicable to a wider range of diseases and patients, and the annual number of operations performed is increasing globally [1]. The acute physiology and chronic health evaluation (APACHE), the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and others have been reported to be highly useful, and many revised versions with improved accuracy have been reported [5,6,7]. While these methods have been designed for presumptive use in the field of intensive care, the large number of essential test items and complex

Methods

Results

Conclusion