Comparison of Risk Scoring Systems to Predict the Outcome in ASA-PS V Patients Undergoing Surgery

Abstract

Operative decision in American Society of Anesthesiology Physical Status (ASA-PS) V patient is difficult as this group of patients expected to have high mortality rate. Another risk scoring system in this ASA-PS V subset of patients can aid to ease this decision.Data of ASA-PS V classified patients between 2011 and 2013 years in a single hospital were analyzed in this study. Predicted mortality of these patients was determined with acute physiology and chronic health evaluations (APACHE) II, simplified acute physiology score (SAPS II), Charlson comorbidity index (CCI), Porthsmouth physiological and operative severity score for enumeration of mortality and morbidity (P-POSSUM), Surgical apgar score (SAS), and Goldman cardiac risk index (GCRI) scores. Observed and predicted mortality rates according to the risk indexes in these patients were compared at survivor and nonsurvivor group of patients. Risk stratification was made with receiver operator characteristic (ROC) curve analysis.Data of 89 patients were included in the analyses. Predicted mortality rates generated by APACHE II and SAPS II scoring systems were significantly different between survivor and nonsurvivor group of patients. Risk stratification with ROC analysis revealed that area under curve was 0.784 and 0.681 for SAPS II and APACHE II scoring systems, respectively. Highest sensitivity (77.3) is reached with SAPS II score.APACHE II and SAPS II are better predictive tools of mortality in ASA-PS V classified subset of patients. Discrimination power of SAPS II score is the best among the compared risk stratification scores. SAPS II can be suggested as an additional risk scoring system for ASA-PS V patients.

Comparative analysis of APACHE-II and P-POSSUM scoring systems in predicting postoperative mortality in patients undergoing emergency laparotomy

“…While some studies have tried comparing APACHE-II and P-POSSUM across all surgeries[25], others have used it for specific pathologies[26,27]. To date, no study with statistically significant sample size has compared APACHE-II and P-POSSUM in its ability to predict mortality in patients undergoing emergency laparotomy.…”

Accuracy of pleth variability index compared with inferior vena cava diameter to predict fluid responsiveness in mechanically ventilated patients

“…The SAPS II score is correlated with a bad prognosis and mortality in sepsis patients. [ 29 , 30 ] The patients participating in our study had a mean SAPS II score of 51.4 ± 7.01. There were 6 patients using vasoactive drugs in the responder group and four in the non-responder group.…”

SASA: una escala sencilla de mortalidad postoperatoria explorada en un centro de atención de tercer nivel en México

“…Para ello, continúan en uso algunas evaluaciones de salud como la fisiología aguda y evaluación crónica de la salud (APACHE II), la puntuación simplificada de fisiología aguda (SAPS II), el índice de comorbilidad de Charlson (CCI), la puntuación operativa fisiológica y de gravedad para la enumeración de mortalidad y morbilidad (POSSUM) y el índice de riesgo cardíaco Goldman (GCRI), pero se han manifestado preocupaciones: su aplicación se documenta principalmente en unidades de cuidados intensivos o en pacientes estratificados como ASA V (6) . POSSUM, por ejemplo, evalúa sólo los factores intraoperatorios, SAPS y APACHE, por el contrario, carecen de consideraciones intraoperatorias importantes, el GCRI proporciona posibles complicaciones cardíacas durante la cirugía no cardíaca, y el CCI arroja una tasa de mortalidad basada en enfermedades del paciente (7,8) .…”