Preoperative Evaluation and Risk Assessment Scoring

Ravi P. Kiran; Conor P. Delaney; Anthony J. Senagore

doi:10.1055/s-2003-40587

Clinics in Colon and Rectal Surgery, Table of Contents

Clin Colon Rectal Surg 2003; 16(2): 075-084
DOI: 10.1055/s-2003-40587

Preoperative Evaluation and Risk Assessment Scoring

Ravi P. Kiran, Conor P. Delaney, Anthony J. Senagore

Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio

Abstract

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

Full Text

References

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
2 Mangano D T. Perioperative cardiac morbidity. Anaesthesiology . 1990; 72 153-184
3 Evans B A, Wijdicks E F. High-grade carotid stenosis detected before general surgery: is endarterectomy indicated?. Neurology . 2001; 57 1328-1330
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
5 Arvidsson S. Preparation of adult patients for anaesthesia and surgery. Acta Anaethesiol Scand . 1996; 40 962-970
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
7 King M S. Preoperative evaluation. Am Fam Physician . 2000; 62 387-396
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
9 Mancuso C A. Impact of new guidelines on physicians' ordering of preoperative tests. J Gen Intern Med . 1999; 14 166-172
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
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
12 McKee R F, Scott E M. The value of routine preoperative investigations. Ann R Coll Surg . 1987; 69 160-162
13 Muskett A D, McGreevy J M. Rational preoperative evaluation. Postgrad Med J . 1986; 62 925-928
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
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
16 Roizen M F. Preoperative evaluation. In: Miller RD, ed. Anesthesia, 4th ed Vol. 1. New York: Churchill Livingstone 1994: 827-882
17 Roizen M. Preoperative evaluation. Can J Anaesth . 1989; 36 S13-S19
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
19 Rucker L, Frye E B, Staten M A. Usefulness of screening chest roentgenograms in preoperative patients. JAMA . 1983; 250 3209-3211
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
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
22 National Study by the Royal College of Radiologists. Preoperative chest radiography. Lancet . 1979; 2 83-86
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
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
26 Jakobsson A. Routine preoperative electrocardiograms. Lancet . 1984; 1 972
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
28 American Diabetes Association. Clinical Practice Recommendations 1998. Screening for type 2 diabetes (position statement). Diabetes Care . 1998; 21 S20-S22
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
30 Klotz H P, Candinas D, Platz A. et al . Preoperative risk assessment in elective general surgery. Br J Surg . 1996; 83 1788-1791
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
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
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
34 Greenburg A G, Saik R P, Pridham D. Influence of age on mortality of colon surgery. Am J Surg . 1985; 150 65-70
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
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
37 Cooperman M, Pflug B, Martin E W. et al . Cardiovascular risk factors in patients with peripheral vascular disease. Surgery . 1978; 84 505-509
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
39 American Society of Anesthesiologists. New classification of physical status. Anaesthesiology . 1963; 24 111
40 Keats A. The ASA classification of physical status-a recapitulation. Anaesthesiology . 1978; 49 233-236
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
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
43 Owens W D, Dykes M HM, Gilbert J P. et al . Development of two indices of postoperative morbidity. Surgery . 1975; 77 586-592
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
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
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
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
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
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
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
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
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
53 Elebute E A, Stoner H B. The grading of sepsis. Br J Surg . 1983; 70 29-31
54 Copeland G P, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg . 1991; 78 355-360
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
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
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
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
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
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
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.
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
63 Keene A R, Cullen D J. Therapeutic Intervention Scoring System: update 1983. Crit Care Med . 1983; 11 1-3
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
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
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
67 Champion H R, Sacco W J, Carnazzo A J, Copes W, Fouty W J. Trauma score. Crit Care Med . 1981; 9 672-676
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
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
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
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