The Surgical Mortality Probability Model

Glance, Laurent G.; Lustik, Stewart J.; Hannan, Edward L.; Osler, Turner M.; Mukamel, Dana B.; Qian, Feng; Dick, Andrew W.

doi:10.1097/sla.0b013e31824b45af

Cited by 283 publications

(121 citation statements)

References 47 publications

(55 reference statements)

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“…1415 It has also shown modest ability to predict postoperative cardiac complications, 1130 and been an important component of models designed to predict postoperative mortality and morbidity. 6831 This consistent demonstration of moderate predictive validity by the ASA-PS scale, both in our present study and previous research, supports its use as a component of risk-adjustment models for comparing surgical outcomes across hospitals. The ASA-PS score is incorporated into the risk-adjustment model used by the National Surgical Quality Improvement Program to measure the quality of surgical care across US hospitals.…”

Section: Discussionsupporting

confidence: 90%

Reliability of the American Society of Anesthesiologists physical status scale in clinical practice

Sankar

Johnson

Beattie

et al. 2014

British Journal of Anaesthesia

410

175

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BackgroundPrevious studies, which relied on hypothetical cases and chart reviews, have questioned the inter-rater reliability of the ASA physical status (ASA-PS) scale. We therefore conducted a retrospective cohort study to evaluate its inter-rater reliability and validity in clinical practice.MethodsThe cohort included all adult patients (≥18 yr) who underwent elective non-cardiac surgery at a quaternary-care teaching institution in Toronto, Ontario, Canada, from March 2010 to December 2011. We assessed inter-rater reliability by comparing ASA-PS scores assigned at the preoperative assessment clinic vs the operating theatre. We also assessed the validity of the ASA-PS scale by measuring its association with patients' preoperative characteristics and postoperative outcomes.ResultsThe cohort included 10 864 patients, of whom 5.5% were classified as ASA I, 42.0% as ASA II, 46.7% as ASA III, and 5.8% as ASA IV. The ASA-PS score had moderate inter-rater reliability (κ 0.61), with 67.0% of patients (n=7279) being assigned to the same ASA-PS class in the clinic and operating theatre, and 98.6% (n=10 712) of paired assessments being within one class of each other. The ASA-PS scale was correlated with patients' age (Spearman's ρ, 0.23), Charlson comorbidity index (ρ=0.24), revised cardiac risk index (ρ=0.40), and hospital length of stay (ρ=0.16). It had moderate ability to predict in-hospital mortality (receiver-operating characteristic curve area 0.69) and cardiac complications (receiver-operating characteristic curve area 0.70).ConclusionsConsistent with its inherent subjectivity, the ASA-PS scale has moderate inter-rater reliability in clinical practice. It also demonstrates validity as a marker of patients' preoperative health status.

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Section: Discussionsupporting

confidence: 90%

Reliability of the American Society of Anesthesiologists physical status scale in clinical practice

Sankar

Johnson

Beattie

et al. 2014

British Journal of Anaesthesia

410

175

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“…In particular, ISOS only included patients undergoing elective surgery. Previous mortality estimates for unselected patient populations undergoing inpatient surgery vary between 1 and 4% 15–18 . A recent study of postoperative mortality in Europe suggested in-hospital mortality of 3% for elective inpatient surgery, 11 similar to overall mortality rates in reports from the USA 9 …”

Section: Discussionmentioning

confidence: 76%

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries

2016

British Journal of Anaesthesia

435

140

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Background: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care.Methods: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries.Results: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2–7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries.Conclusions: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care.Study registration: ISRCTN51817007

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“…Each patient was assigned a Surgical Mortality Probability Model (S-MPM) risk score and class level described by Glance et al 6 The S-MPM risk score for each patient was determined from 3 risk factors: American Society of Anesthesiologists Physical Status (ASA-PS), surgical risk category, and emergency status. The point value of the score ranged from 0 to 9 and was classified into 3 levels with an associated risk of 30-day mortality assigned to each class (ie, class I: 0–4, <0.50% mortality; class II: 5–6, 1.5%−4.0% mortality; class III 7–9, >10% mortality).…”

Section: Methodsmentioning

confidence: 99%

“…The point value of the score ranged from 0 to 9 and was classified into 3 levels with an associated risk of 30-day mortality assigned to each class (ie, class I: 0–4, <0.50% mortality; class II: 5–6, 1.5%−4.0% mortality; class III 7–9, >10% mortality). 6 …”

Section: Methodsmentioning

confidence: 99%

The Implementation of a Preoperative Transthoracic Echocardiography Consult Service by Anesthesiologists

Shillcutt

Walsh

Thomas

et al. 2017

Anesthesia &Amp; Analgesia

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We describe a preoperative transthoracic echocardiography consult service led by anesthesiologists. The implementation process and the patient cohort are described. Preoperative transthoracic echocardiographic examinations were mostly performed in patients undergoing intermediate or high-risk noncardiac surgery and in patients with a higher calculated mortality risk. All transthoracic echocardiographic examinations were interpreted by anesthesiologists.

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The Surgical Mortality Probability Model

Cited by 283 publications

References 47 publications

Reliability of the American Society of Anesthesiologists physical status scale in clinical practice

Reliability of the American Society of Anesthesiologists physical status scale in clinical practice

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries

The Implementation of a Preoperative Transthoracic Echocardiography Consult Service by Anesthesiologists

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