The use of risk stratification tools for perioperative and postoperative morbidity and mortality

Havens JM, Columbus AB, Seshadri AJ, et al. Risk stratification tools in emergency general surgery. Trauma Surg Acute Care Open. 2018 Apr 29;3(1):e000160.

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The use of risk stratification tools (RST) aids in clinical triage, decision making and quality assessment in a wide variety of medical fields. Although emergency general surgery (EGS) is characterized by a comorbid, physiologically acute patient population with disparately high rates of perioperative morbidity and mortality, few RST have been explicitly examined in this setting. We examined the available RST with the intent of identifying a tool that comprehensively reflects an EGS patients perioperative risk for death or complication.

We believe the ideal RST for EGS will meet six criteria for the generalized EGS patient population:

  1. Accurately quantify morbidity and mortality risk in the EGS population.
  2. Use readily obtainable objective data.
  3. Be applicable early prior to a surgical intervention.
  4. Be applicable in non-operative cases.
  5. Can be used for auditing purposes.
  6. Application that facilitates use in clinical practice.

ESG risk tool

Lee SG, Russ A. Predicting and Preventing Postoperative Outcomes. Clin Colon Rectal Surg. 2019 May;32(3):149-156.

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Article Contents: 

What Are the Current Predictive Models of Postoperative Risks in Colorectal Surgery and Are They Useful or Practical?

  • American College of Surgeons National Surgery Quality Improvement Program NSQIP Risk Calculator (ACS-NSQIP)
  • Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM)

What Are the Preoperative Risk Factors for Morbidity and Mortality in Colorectal Surgery?

  • Nonmodifiable Risk Factors
    • Age
    • Gender
    • Prior Abdominal Surgery
    • Medical Comorbidities and Health Status Prior to Surgery
  • Modifiable Risk Factors
    • Obesity
    • Nutritional Status
    • Smoking and Alcohol Consumption

How Can We Best Optimize Our Patients to Minimize Postoperative Complications

  • Preoperative Discussion and Ostomy Education
  • Nutrition
  • Prehabilitation
  • Bowel Preparation

Bose S, Talmor D. Who is a high-risk surgical patient? Curr Opin Crit Care. 2018 Dec; 24(6):547-553.

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high risk table

More PubMed results on identifying high-risk acute surgery patients.

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