Download PDF
Clin Colon Rectal Surg 2003; 16(2): 075-084
DOI: 10.1055/s-2003-40587
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Preoperative Evaluation and Risk Assessment Scoring

Ravi P. Kiran, Conor P. Delaney, Anthony J. Senagore
  • Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
Further Information

Publication History

Publication Date:
18 July 2003 (online)

    Permissions and Reprints

ABSTRACT

Proper assessment of patients before surgery is of paramount importance to avoid untoward surgical and anesthetic events. Assessment should include history, a thorough physical examination, and tests directed at specific diagnosis in select patients. Current evidence indicates that many tests that are routinely performed are unnecessary and do not alter management or outcome. Various scoring systems have been employed for assessment of risk of patients and comparison of performance between surgical units but none have passed into routine practice.

KEYWORDS

Preoperative evaluation - risk scoring

REFERENCES

  • 1 Arvidsson S, Ouchterlony J, Nilsson S, Sjosted L, Svardsudd K. The Gothenburg study of perioperative risk. I. Preoperative findings, postoperative complications.  Acta Anaethesiol Scand . 1994;  38 679-690
    PubMedGoogle Scholar
  • 2 Mangano D T. Perioperative cardiac morbidity.  Anaesthesiology . 1990;  72 153-184
    CrossrefPubMedGoogle Scholar
  • 3 Evans B A, Wijdicks E F. High-grade carotid stenosis detected before general surgery: is endarterectomy indicated?.  Neurology . 2001;  57 1328-1330
    PubMedGoogle Scholar
  • 4 Campos A C, Meguid M M. A critical appraisal of the usefulness of perioperative nutritional support.  Am J Clin Nutr . 1992;  55 117-130
    PubMedGoogle Scholar
  • 5 Arvidsson S. Preparation of adult patients for anaesthesia and surgery.  Acta Anaethesiol Scand . 1996;  40 962-970
    PubMedGoogle Scholar
  • 6 Badner N H, Craen R A, Paul T L, Doyle J A. Anaesthesia preadmission assessment: a new approach through use of a screening questionnaire.  Can J Anaesth . 1998;  45 87-92
    PubMedGoogle Scholar
  • 7 King M S. Preoperative evaluation.  Am Fam Physician . 2000;  62 387-396
    PubMedGoogle Scholar
  • 8 Goldman L, Caldera D L, Nussbaum S R, et al: Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med .  1977;  297 845-850
    CrossrefPubMedGoogle Scholar
  • 9 Mancuso C A. Impact of new guidelines on physicians' ordering of preoperative tests.  J Gen Intern Med . 1999;  14 166-172
    CrossrefPubMedGoogle Scholar
  • 10 Greer A E, Irwin M G. Implementation and evaluation of guidelines for preoperative testing in a tertiary hospital.  Anaesth Intensive Care . 2002;  30 326-330
    PubMedGoogle Scholar
  • 11 Ricciardi G, Angelillo I F, Del Prete U. et al . Routine preoperative investigation. Results of a multicenter survey in Italy. Collaborator Group.  Int J Technol Assess Health Care . 1998;  14 526-534
    PubMedGoogle Scholar
  • 12 McKee R F, Scott E M. The value of routine preoperative investigations.  Ann R Coll Surg . 1987;  69 160-162
    PubMedGoogle Scholar
  • 13 Muskett A D, McGreevy J M. Rational preoperative evaluation.  Postgrad Med J . 1986;  62 925-928
    PubMedGoogle Scholar
  • 14 Pedersen T, Eliasen K, Henriksen E. A prospective study of mortality associated with anesthesia and surgery: risk indicators of mortality in hospital.  Acta Anaesthesiol Scand . 1990;  34 176-182
    PubMedGoogle Scholar
  • 15 Haug R h, Reifis R L. A prospective evaluation of the value of preoperative laboratory testing for office anesthesia and sedation.  J Oral Maxillofac Surg . 1999;  57 16-20
    CrossrefPubMedGoogle Scholar
  • 16 Roizen M F. Preoperative evaluation. In: Miller RD, ed. Anesthesia, 4th ed Vol. 1. New York: Churchill Livingstone 1994: 827-882
    Google Scholar
  • 17 Roizen M. Preoperative evaluation.  Can J Anaesth . 1989;  36 S13-S19
    PubMedGoogle Scholar
  • 18 Macario A, Roizen M F, Thisted R A, Kim S, Orkin F K, Phelps C. Reassessment of preoperative laboratory testing has changed the test-ordering patterns of physicians.  Surg Gynecol Obstet . 1992;  175 539-547
    PubMedGoogle Scholar
  • 19 Rucker L, Frye E B, Staten M A. Usefulness of screening chest roentgenograms in preoperative patients.  JAMA . 1983;  250 3209-3211
    CrossrefPubMedGoogle Scholar
  • 20 Umbach G E, Zubek S, Deck H J, Buhl R, Bender H G, Jungblat R M. The value of preoperative chest x-rays in gynecological patients.  Arch Gynecol Obstet . 1988;  243 179-185
    CrossrefPubMedGoogle Scholar
  • 21 Charpak Y, Blery C, Chastang C, Szatan M, Fourgeaux B. Prospective assessment of a protocol for selective ordering of preoperative chest x-rays.  Can J Anaesth . 1988;  35 259-264
    PubMedGoogle Scholar
  • 22 National Study by the Royal College of Radiologists. Preoperative chest radiography.  Lancet . 1979;  2 83-86
    PubMedGoogle Scholar
  • 23 American College of Radiology. Referral criteria for chest x-ray examinations (policy statement) Chicago: American College of Radiology; 1982
  • 24 Blery C, Chastang C, Gaudy J H. Critical assessment of routine preoperative investigations.  Effective Health Care . 1983;  1 111-114
    PubMedGoogle Scholar
  • 25 Archer C, Levy A R, McGregor M. Value of routine preoperative chest x-rays: a meta-analysis.  Can J Anaesth . 1993;  40 1022-1027
    CrossrefPubMedGoogle Scholar
  • 26 Jakobsson A. Routine preoperative electrocardiograms.  Lancet . 1984;  1 972
    PubMedGoogle Scholar
  • 27 Mantha S, Roizen M F, Barnard J, Thisted R A, Ellis J E, Foss J. Relative effectiveness of four preoperative tests for predicting adverse cardiac outcomes after vascular surgery: a meta-analysis.  Anesth Analg . 1994;  79 422-433
    PubMedGoogle Scholar
  • 28 American Diabetes Association. Clinical Practice Recommendations 1998. Screening for type 2 diabetes (position statement).  Diabetes Care . 1998;  21 S20-S22
    PubMedGoogle Scholar
  • 29 Arvidsson S, Ouchterlony J, Sjostedt L, Svardsudd. Predicting postoperative adverse events. Clinical efficiency of four general classification systems. The project perioperative risk.  Acta Anaesthesiol Scand . 1996;  40 783-791
    PubMedGoogle Scholar
  • 30 Klotz H P, Candinas D, Platz A. et al . Preoperative risk assessment in elective general surgery.  Br J Surg . 1996;  83 1788-1791
    PubMedGoogle Scholar
  • 31 Hartley M N, Sagar P M. The surgeon's 'gut feeling' as a predictor of post-operative outcome.  Ann R Coll Surg Engl . 1994;  76(suppl 6) S277-S278
    PubMedGoogle Scholar
  • 32 Lawrence V A, Dhanda R, Hilsenbeck S G, Page C P. Risk of pulmonary complications after elective abdominal surgery.  Chest . 1996;  110 744-750
    PubMedGoogle Scholar
  • 33 Mullen J L, Buzby G P, Waldman M T, Gertner M H, Hobbs C L, Rosato E F. Prediction of operative morbidity and mortality by preoperative nutritional assessment.  Surg Forum . 1979;  30 80-82
    PubMedGoogle Scholar
  • 34 Greenburg A G, Saik R P, Pridham D. Influence of age on mortality of colon surgery.  Am J Surg . 1985;  150 65-70
    CrossrefPubMedGoogle Scholar
  • 35 Buzby G P, Mullen J L, Matthews D C, Hobbs C L, Rosato E F. Prognostic nutritional index in gastrointestinal surgery.  Am J Surg . 1980;  139 160-167
    CrossrefPubMedGoogle Scholar
  • 36 Boyd J B, Bradford Jr B, Watne A L. Operative risk factors of colon resection in the elderly.  Ann Surg . 1980;  192 743-746
    PubMedGoogle Scholar
  • 37 Cooperman M, Pflug B, Martin E W. et al . Cardiovascular risk factors in patients with peripheral vascular disease.  Surgery . 1978;  84 505-509
    PubMedGoogle Scholar
  • 38 Detsky A, Abrams H, McLaughlin J. et al . Predicting cardiac complications in patients undergoing non-cardiac surgery.  J Gen Intern Med . 1986;  1 211-219
    CrossrefPubMedGoogle Scholar
  • 39 American Society of Anesthesiologists. New classification of physical status.  Anaesthesiology . 1963;  24 111
    PubMedGoogle Scholar
  • 40 Keats A. The ASA classification of physical status-a recapitulation.  Anaesthesiology . 1978;  49 233-236
    CrossrefPubMedGoogle Scholar
  • 41 Vacanti C J, Van Houten J R, Hill R C. A statistical analysis of the relationship of physical status to postoperative mortality in 63,388 cases.  Anesth Analg . 1970;  49 564-566
    PubMedGoogle Scholar
  • 42 Menke H, Klein A, John K D, Junginger T. Predictive value of ASA Classification for the assessment of perioperative risk.  Int Surg . 1993;  78 266-270
    PubMedGoogle Scholar
  • 43 Owens W D, Dykes M HM, Gilbert J P. et al . Development of two indices of postoperative morbidity.  Surgery . 1975;  77 586-592
    PubMedGoogle Scholar
  • 44 Wolters U, Wolf T, Stutzer H, Schroder T. ASA classification and perioperative variables as predictors of postoperative outcome.  Br J Anaesth . 1996;  77 217-222
    CrossrefPubMedGoogle Scholar
  • 45 Mullen J L, Gertner M H, Buzby G P, Goodhart G L, Rosato E F. Implications of malnutrition in the surgical patient.  Arch Surg . 1979;  114 121-125
    CrossrefPubMedGoogle Scholar
  • 46 Knaus W A, Zimmerman J E, Wagner D P, Draper E A, Lawrence D E. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system.  Crit Care Med . 1981;  9 591-597
    CrossrefPubMedGoogle Scholar
  • 47 Knaus W A, Draper E A, Wagner D P, Zimmerman J E. APACHE II: a severity of disease classification system.  Crit Care Med . 1985;  13 818-829
    CrossrefPubMedGoogle Scholar
  • 48 Goffi L, Saba V, Ghiselli R, Necozione S, Mattei A, Carle F. Preoperative APACHE II and ASA scores in patients having major general surgical operations: prognostic value and potential clinical applications.  Eur J Surg . 1999;  165 730-735
    CrossrefPubMedGoogle Scholar
  • 49 Koperna T, Semmler D, Marian F. Risk stratification in emergency surgical patients: is the APACHE II score a reliable marker of physiological impairment?.  Arch Surg . 2001;  136 55-59
    PubMedGoogle Scholar
  • 50 Knaus W A, Wagner D P, Draper E A. et al . The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults.  Chest . 1991;  100 1619-1636
    CrossrefPubMedGoogle Scholar
  • 51 Le Gall R J, Loirat P, Alperovitch A. et al . A simplified acute physiology score for ICU patients.  Crit Care Med . 1984;  12 975-977
    CrossrefPubMedGoogle Scholar
  • 52 Harvey K B, Moldawer L L, Bistrian B R, Blackburn G L. Biological measures for the formulation of a hospital prognostic index.  Am J Clin Nutr . 1981;  34 2013-2022
    PubMedGoogle Scholar
  • 53 Elebute E A, Stoner H B. The grading of sepsis.  Br J Surg . 1983;  70 29-31
    PubMedGoogle Scholar
  • 54 Copeland G P, Jones D, Walters M. POSSUM: a scoring system for surgical audit.  Br J Surg . 1991;  78 355-360
    CrossrefPubMedGoogle Scholar
  • 55 Jones D R, Copeland G P, de Cossart L. Comparison of POSSUM with APACHE II for prediction of outcome from a surgical high-dependency unit.  Br J Surg . 1992;  79 1293-1296
    CrossrefPubMedGoogle Scholar
  • 56 Prytherch D R, Whiteley M S, Higgins B, Weaver P C, Prout W G, Powell S J. POSSUM and Portsmouth POSSUM for predicting mortality. Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity.  Br J Surg . 1998;  85 1217-1220
    CrossrefPubMedGoogle Scholar
  • 57 Wijesinghe L D, Mahmood T, Scott D J, Berridge D C, Kent P J, Kester R C. Comparison of POSSUM and the Portsmouth predictor equation for predicting death following vascular surgery.  Br J Surg . 1998;  85 209-212
    CrossrefPubMedGoogle Scholar
  • 58 Kuhan G, Abidia A F, Wijesinghe L D. et al . POSSUM and P-POSSUM overpredict mortality for carotid endarterectomy.  Eur J Vasc Endovasc Surg . 2002;  23 209-211
    CrossrefPubMedGoogle Scholar
  • 59 Midwinter M J, Tytherleigh M, Ashley S. Estimation of mortality and morbidity risk in vascular surgery using POSSUM and the Portsmouth predictor equation.  Br J Surg . 1999;  86 471-474
    CrossrefPubMedGoogle Scholar
  • 60 Tekkis P P, Kocher H M, Bentley A J. et al . Operative mortality rates among surgeons: comparison of POSSUM and p-POSSUM scoring systems in gastrointestinal surgery.  Dis Colon Rectum . 2000;  43 1528-1534
    PubMedGoogle Scholar
  • 61 Senagore A J, Duepree H J, Delaney C P, Brady K, Fazio V W. Evaluation of POSSUM and p-POSSUM scoring systems in assessing outcomes with laparoscopic colectomy (in press).  Br J Surg.
    PubMedGoogle Scholar
  • 62 Cullen D J, Civetta J M, Briggs B A, Ferrara L C. Therapeutic intervention scoring system: a method for quantitative comparison of patient care.  Crit Care Med . 1974;  2 57-60
    CrossrefPubMedGoogle Scholar
  • 63 Keene A R, Cullen D J. Therapeutic Intervention Scoring System: update 1983.  Crit Care Med . 1983;  11 1-3
    Google Scholar
  • 64 Lemeshow S, Teres D, Pastides H, Avrunin J S, Steingrub J S. A method for predicting survival and mortality of ICU patients using objectively derived weights.  Crit Care Med . 1985;  13 519-525
    CrossrefPubMedGoogle Scholar
  • 65 Matsusue S, Kashihara S, Koizumi S. Prediction of mortality from septic shock in gastrointestinal surgery by probit analysis.  Jpn J Surg . 1988;  18 18-22
    PubMedGoogle Scholar
  • 66 Charlson M E, Pompei P, Ales K L, MacKenzie C R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.  J Chronic Dis . 1987;  40 373-383
    CrossrefPubMedGoogle Scholar
  • 67 Champion H R, Sacco W J, Carnazzo A J, Copes W, Fouty W J. Trauma score.  Crit Care Med . 1981;  9 672-676
    CrossrefPubMedGoogle Scholar
  • 68 Agarwal N, Leighton L, Mandile M A, Cayten C G. Outcomes of surgery for colorectal cancer in patients age 80 years and older.  Am J Gastroenterol . 1990;  85 1096-1101
    PubMedGoogle Scholar
  • 69 Ondrula D P, Nelson R L, Prasad M L, Coyle B W, Abcarian H. Multifactorial index of preoperative risk factors in colon resections.  Dis Colon Rectum . 1992;  35 117-122
    CrossrefPubMedGoogle Scholar
  • 70 Sagar P M, Hartley M N, Mancey-Jones B, Sedman P C, May J, Macfie J. Comparative audit of colorectal resection with the POSSUM scoring system.  Br J Surg . 1994;  81 1492-1494
    PubMedGoogle Scholar
  • 71 Sagar P M, Hartley M N, MacFie J, Taylor B A, Copeland G P. Comparison of individual surgeon's performance. Risk-adjusted analysis with POSSUM scoring system.  Dis Colon Rectum . 1996;  39 654-658
    PubMedGoogle Scholar
      >