Integral scales in assessing the risk of postoperative morbidity and mortality

Close metadata

Recommended articles:

Types of fillers and their characteristics (part 1). Plastic Surgery and Aesthetic Medicine. 2023;(1):67-76

Deep anterior lamellar keratoplasty in extrusion of an incomplete intrastromal corneal ring segment (clinical observation). Russian Annals of Ophthalmology. 2023;(1):75-79

Implantation of cardiac contractility modulation device. (Analysis of complications in a 24-month follow-up). Russian Cardiology Bulletin. 2023;(1):65-72

Results of the implementation of measures aimed at improving medical care for patients with vascular diseases in the Tomsk region. S.S. Korsakov Journal of Neurology and Psychiatry. 2023;(3-2):85-93

Surgery for lung cancer in elderly and senile patients: a ten-year experience of two centers. P.A. Herzen Journal of Oncology. 2023;(2):11-18

Surgical treatment of epilepsy in children with focal cortical dysplasia in central gyri. Burdenko's Journal of Neurosurgery. 2023;(2):17-21

Results of surgical treatment in patients with critical ischemia of the lower limbs and complications of endovascular interventions. Russian Journal of Cardiology and Cardiovascular Surgery. 2017;(1):47-50

Clinical features and treatment of endophthalmitis after cataract surgery. Russian Annals of Ophthalmology. 2023;(2):52-60

Morphological aspects of diaphragm dysfunction in COVID-19-associated pneumonia. Russian Journal of Archive of Patology. 2023;(3):19-22

Acute limb ischemia in patients with COVID-19. Russian Journal of Cardiology and Cardiovascular Surgery. 2023;(3):267-271

Annual number of surgeries exceeds 10 million In Russia, and this number is increasing every year. Searching for a scale or index determining the risk of postoperative complications and mortality is an important issue all over the world. The authors analyzed all available risk assessment scales for postoperative morbidity and mortality. The most significant ones in historical aspect and modern perspective grading systems were highlighted. We compared these indices with clinical recommendations and necessary preoperative preparation. Thus, these scales are valuable for surgeons and anesthesiologists to assess the risk, volume of surgical intervention and methods of preoperative management. However, they are not perfect and require improvement. Therefore, development of such scales is a priority objective of medicine in the foreseeable future.

Keywords:

integral scales

risk assessment

mortality

complications

Authors:

Z.A. Bagateliya

Botkin Clinical Hospital

ORCID: 0000-0001-5699-3695

D.N. Grekov

Botkin Clinical Hospital

ORCID: 0000-0001-8391-1210

A.G. Komarova

Botkin Clinical Hospital

ORCID: 0000-0002-8633-7012

V.M. Kulushev

Botkin Clinical Hospital

ORCID: 0000-0003-0677-2338

N.Yu. Sokolov

Botkin Clinical Hospital

ORCID: 0000-0002-0706-9575

I.N. Kuts

Botkin Clinical Hospital

ORCID: 0000-0003-1516-6110

M.S. Lebedko

Botkin Clinical Hospital

ORCID: 0000-0002-3987-9361

Received:

20.06.2023

Accepted:

10.07.2023

List of references:

Devereaux PJ, Sessler DI. Cardiac Complications in Patients Undergoing Major Noncardiac Surgery. The New England Journal of Medicine. 2015;373(23):2258-2269. https://doi.org/10.1056/NEJMra1502824
Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, Ford I, Gonzalez-Juanatey JR, Gorenek B, Heyndrickx GR, Hoeft A, Huber K, Iung B, Kjeldsen KP, Longrois D, Lüscher TF, Pierard L, Pocock S, Price S, Roffi M, Sirnes PA, Sousa-Uva M, Voudris V, Funck-Brentano C; Authors/Task Force Members. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). European Heart Journal. 2014;35(35):2383-23431. https://doi.org/10.1093/eurheartj/ehu282
Mureddu GF. Current multivariate risk scores in patients undergoing non-cardiac surgery. Monaldi Archives for Chest Disease. 2017;87(2):848.
Saklad M. Grading of patients for surgical procedures. Anesthesiology. 1941;2:281-284.
Roques F, Nashef SA, Michel P. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19,030 patients. European Journal of Cardio-Thoracic Surgery. 1999;15:816-823.
Glance IG, Lustft S3, Mannar EL. The Surgical Mortality Pubability Model derivation and validation of a simple risk prediction rule for noncardiac surgery. Annals of Surgery. 2012;255:696-702.
Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, De Hert S, de Laval I, Geisler T, Hinterbuchner L, Ibanez B, Lenarczyk R, Mansmann UR, McGreavy P, Mueller C, Muneretto C, Niessner A, Potpara TS, Ristić A, Sade LE, Schirmer H, Schüpke S, Sillesen H, Skulstad H, Torracca L, Tutarel O, Van Der Meer P, Wojakowski W, Zacharowski K; ESC Scientific Document Group. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. European Heart Journal. 2022;43(39):3826-3924. https://doi.org/10.1093/eurheartj/ehac270
Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, Fleisher LA, Froehlich JB, Gusberg RJ, Leppo JA, Ryan T, Schlant RC, Winters WL Jr, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Jacobs AK, Hiratzka LF, Russell RO, Smith SC Jr; American College of Cardiology; American Heart Association. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). JACC: Cardiovascular Interventions. 2002;39(3):542-53. https://doi.org/10.1016/s0735-1097(01)01788-0
Smilowitz NR, Gupta N, Ramakrishna H, Guo Y, Berger JS, Bangalore S. Perioperative Major Adverse Cardiovascular and Cerebrovascular Events Associated With Noncardiac Surgery. JAMA Cardiology. 2017;2(2):181-187. https://doi.org/10.1001/jamacardio.2016.4792
Smetana GW. Preoperative pulmonary evaluation. The New England Journal of Medicine. 1999;340(12):937-944. https://doi.org/10.1056/NEJM199903253401207
Lurati Buse GAL, Puelacher C, Gualandro DM, Genini AS, Hidvegi R, Bolliger D, Arslani K, Steiner LA, Kindler C, Mueller C; BASEL-PMI Investigators. Association between self-reported functional capacity and major adverse cardiac events in patients at elevated risk undergoing noncardiac surgery: a prospective diagnostic cohort study. British Journal of Anaesthesia. 2021;126(1):102-110. https://doi.org/10.1016/j.bja.2020.08.041
Pierre S, Rivera C, Le Maître B, Ruppert AM, Bouaziz H, Wirth N, Saboye J, Sautet A, Masquelet AC, Tournier JJ, Martinet Y, Chaput B, Dureuil B. Guidelines on smoking management during the perioperative period. Anaesthesia Critical Care & Pain Medicine. 2017;36(3):195-200. https://doi.org/10.1016/j.accpm.2017.02.002
Grønkjær M, Eliasen M, Skov-Ettrup LS, Tolstrup JS, Christiansen AH, Mikkelsen SS, Becker U, Flensborg-Madsen T. Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Annals of Surgery. 2014;259(1):52-71. https://doi.org/10.1097/SLA.0b013e3182911913
Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. Meta-analysis of the association between preoperative anaemia and mortality after surgery. British Journal of Surgery. 2015;102(11):1314-1324. https://doi.org/10.1002/bjs.9861
Wensink MJ, Lu Y, Tian L, Shaw GM, Rizzi S, Jensen TK, Mathiesen ER, Skakkebæk NE, Lindahl-Jacobsen R, Eisenberg ML. Preconception Antidiabetic Drugs in Men and Birth Defects in Offspring: A Nationwide Cohort Study. Annals of Internal Medicine. 2022;175(5):665-673. https://doi.org/10.7326/M21-4389
POISE Study Group; Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K, Villar JC, Xavier D, Chrolavicius S, Greenspan L, Pogue J, Pais P, Liu L, Xu S, Málaga G, Avezum A, Chan M, Montori VM, Jacka M, Choi P. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371(9627):1839-1847. https://doi.org/10.1016/S0140-6736(08)60601-7
Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. JACC: Cardiovascular Interventions. 2001;37(1):153-156. https://doi.org/10.1016/s0735-1097(00)01054-8
Blessberger H, Lewis SR, Pritchard MW, Fawcett LJ, Domanovits H, Schlager O, Wildner B, Kammler J, Steinwender C. Perioperative beta-blockers for preventing surgery-related mortality and morbidity in adults undergoing cardiac surgery. Cochrane Database and Systematic Reviews. 2019;9(9):CD013435. https://doi.org/10.1002/14651858.CD013435
Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN; American College of Cardiology; American Heart Association. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. JACC: Journal of the American College of Cardiology. 2014;64(22):77-137. https://doi.org/10.1016/j.jacc.2014.07.944
Le Manach Y, Godet G, Coriat P, Martinon C, Bertrand M, Fléron MH, Riou B. The impact of postoperative discontinuation or continuation of chronic statin therapy on cardiac outcome after major vascular surgery. Anesthesia & Analgesia. 2007;104(6):1326-1333, table of contents. https://doi.org/10.1213/01.ane.0000263029.72643.10
Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A, Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, Garcia D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS, Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, Zhu J, Wallentin L; ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. The New England Journal of Medicine. 2011;365(11):981-992. https://doi.org/10.1056/NEJMoa1107039
Writing Committee Members; Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS Jr, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. JACC: Cardiovascular Interventions. 2022;79(2):21-129. https://doi.org/10.1016/j.jacc.2021.09.006
Devereaux PJ, Xavier D, Pogue J, Guyatt G, Sigamani A, Garutti I, Leslie K, Rao-Melacini P, Chrolavicius S, Yang H, Macdonald C, Avezum A, Lanthier L, Hu W, Yusuf S; POISE (PeriOperative ISchemic Evaluation) Investigators. Characteristics and short-term prognosis of perioperative myocardial infarction in patients undergoing noncardiac surgery: a cohort study. Annals of Internal Medicine. 2011;154(8):523-528. https://doi.org/10.7326/0003-4819-154-8-201104190-00003
Graham MM, Sessler DI, Parlow JL, Biccard BM, Guyatt G, Leslie K, Chan MTV, Meyhoff CS, Xavier D, Sigamani A, Kumar PA, Mrkobrada M, Cook DJ, Tandon V, Alvarez-Garcia J, Villar JC, Painter TW, Landoni G, Fleischmann E, Lamy A, Whitlock R, Le Manach Y, Aphang-Lam M, Cata JP, Gao P, Terblanche NCS, Ramana PV, Jamieson KA, Bessissow A, Mendoza GR, Ramirez S, Diemunsch PA, Yusuf S, Devereaux PJ. Aspirin in Patients With Previous Percutaneous Coronary Intervention Undergoing Noncardiac Surgery. Annals of Internal Medicine. 2018;168(4):237-244. https://doi.org/10.7326/M17-2341
McFalls EO, Ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, Pierpont G, Santilli S, Rapp J, Hattler B, Shunk K, Jaenicke C, Thottapurathu L, Ellis N, Reda DJ, Henderson WG. Coronary-artery revascularization before elective major vascular surgery. The New England Journal of Medicine. 2004;351(27):2795-2804. https://doi.org/10.1056/NEJMoa041905
Garcia S, Moritz TE, Goldman S, Littooy F, Pierpont G, Larsen GC, Reda DJ, Ward HB, McFalls EO. Perioperative complications after vascular surgery are predicted by the revised cardiac risk index but are not reduced in high-risk subsets with preoperative revascularization. Circulation: Cardiovascular Quality and Outcomes. 2009;2(2):73-77. https://doi.org/10.1161/CIRCOUTCOMES.108.827683
Flu WJ, van Kuijk JP, Hoeks SE, Kuiper R, Schouten O, Goei D, Elhendy A, Verhagen HJ, Thomson IR, Bax JJ, Fleisher LA, Poldermans D. Prognostic implications of asymptomatic left ventricular dysfunction in patients undergoing vascular surgery. Anesthesiology. 2010;112(6):1316-1324. https://doi.org/10.1097/ALN.0b013e3181da89ca
Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J, Sabaté S, Mazo V, Briones Z, Sanchis J; ARISCAT Group. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6):1338-1350. https://doi.org/10.1097/ALN.0b013e3181fc6e0a
Mazo V, Sabaté S, Canet J, Gallart L, de Abreu MG, Belda J, Langeron O, Hoeft A, Pelosi P. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology. 2014;121(2):219-231. https://doi.org/10.1097/ALN.0000000000000334
Park J, Oh AR, Lee SH, Lee JH, Min JJ, Kwon JH, Kim J, Yang K, Choi JH, Lee SC, Gwon HC, Kim K, Ahn J, Lee SM. Associations Between Preoperative Glucose and Hemoglobin A1c Level and Myocardial Injury After Noncardiac Surgery. J Am Heart Assoc. 2021;10(7):e019216. https://doi.org/10.1161/JAHA.120.019216
Abdelwahab M, Lynch CD, Schneider P, Thung S, Costantine MM, O’Malley D, Landon MB, Pawlik TM, Venkatesh KK. Postoperative complications after non-obstetric surgery among pregnant patients in the National Surgical Quality Improvement Program, 2005-2012. American Journal of Surgery. 2022;223(2):364-369. https://doi.org/10.1016/j.amjsurg.2021.04.002
Balinskaite V, Bottle A, Sodhi V, Rivers A, Bennett PR, Brett SJ, Aylin P. The Risk of Adverse Pregnancy Outcomes Following Nonobstetric Surgery During Pregnancy: Estimates From a Retrospective Cohort Study of 6.5 Million Pregnancies. Annals of Surgery. 2017;266(2):260-266. https://doi.org/10.1097/SLA.0000000000001976
Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. British Journal of Anaesthesia. 1996;77(2):217-222. https://doi.org/10.1093/bja/77.2.217
Mureddu GF. Current multivariate risk scores in patients undergoing non-cardiac surgery. Monaldi Archives for Chest Disease. 2017;87(2):848.
Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, Burke DS, O’Malley TA, Goroll AH, Caplan CH, Nolan J, Carabello B, Slater EE. Multifactorial index of cardiac risk in noncardiac surgical procedures. The New England Journal of Medicine. 1977;297(16):845-850. https://doi.org/10.1056/NEJM197710202971601
Detsky AS, Abrams HB, McLaughlin JR, Drucker DJ, Sasson Z, Johnston N, Scott JG, Forbath N, Hilliard JR. Predicting cardiac complications in patients undergoing non-cardiac surgery. Journal of General Internal Medicine. 1986;1(4):211-219. https://doi.org/10.1007/BF02596184
Gupta PK, Gupta H, Sundaram A, Kaushik M, Fang X, Miller WJ, Esterbrooks DJ, Hunter CB, Pipinos II, Johanning JM, Lynch TG, Forse RA, Mohiuddin SM, Mooss AN. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011;124(4):381-387. https://doi.org/10.1161/CIRCULATIONAHA.110.015701
Gupta PK, Gupta H, Sundaram A, Kaushik M, Fang X, Miller WJ, Esterbrooks DJ, Hunter CB, Pipinos II, Johanning JM, Lynch TG, Forse RA, Mohiuddin SM, Mooss AN. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011;124(4):381-387. https://doi.org/10.1016/j.jamcollsurg.2013.07.385
Sutton R, Bann S, Brooks M, Sarin S. The Surgical Risk Scale as an improved tool for risk-adjusted analysis in comparative surgical audit. British Journal of Surgery. 2002;89(6):763-768. https://doi.org/10.1046/j.1365-2168.2002.02080.x
Protopapa KL, Simpson JC, Smith NC, Moonesinghe SR. Development and validation of the Surgical Outcome Risk Tool (SORT). British Journal of Surgery. 2014;101(13):1774-1783. https://doi.org/10.1002/bjs.9638
Campbell D, Boyle L, Soakell-Ho M, Hider P, Wilson L, Koea J, Merry AF, Frampton C, Short TG. National risk prediction model for perioperative mortality in non-cardiac surgery. British Journal of Surgery. 2019;106(11):1549-1557. https://doi.org/10.1002/bjs.11232
Glance LG, Lustik SJ, Hannan EL, Osler TM, Mukamel DB, Qian F, Dick AW. The Surgical Mortality Probability Model: derivation and validation of a simple risk prediction rule for noncardiac surgery. Annals of Surgery. 2012;255(4):696-702. https://doi.org/10.1097/SLA.0b013e31824b45af
Le Manach Y, Collins G, Rodseth R, Le Bihan-Benjamin C, Biccard B, Riou B, Devereaux PJ, Landais P. Preoperative Score to Predict Postoperative Mortality (POSPOM): Derivation and Validation. Anesthesiology. 2016;124(3):570-579. https://doi.org/10.1097/ALN.0000000000000972
Zabolotskikh IB, Trembach NV, Magomedov MA, Krasnov VG, Chernienko LYu, Shevyrev SN, Popov AS, Tyutyunova EV, Vatutin SN, Malyshev YP, Popov EA, Smolin AA, Kitiashvili IZ, Dmitriev AA, Grigoriev EV, Kameneva EA, Fisher VV, Volkov EV, Yatsuk IV, Levit DA, Sharipov AM, Khoronenko VE, Shemetova MM, Kokhno VN, Polovnikov EV, Spasova AP, Mironov AV, Davydova VR, Shapovalov KG, Gritsan AI, Sorsunov SV, Lebedinsky KM, Dunts PV, Rudnov VA, Stadler VV, Bayalieva AZ, Prigorodov MV, Antonov VF, Voroshin DG, Ovezov AM, Pivovarova AA, Martynov DV, Batigyan OA, Zamyatin MN, Voskanyan SE, Astakhov AA, Khoteev AZ, Protsenko DN, Arykan NG, Zakharchenko IA, Matveev AS, Trembach IA, Musaeva TS Comparative evaluation of scales for predicting adverse postoperative outcome: preliminary results of the IRC «The role of concomitant diseases in risk stratification of postoperative complications in STOPRISK abdominal surgery». Bulletin of Intensive Care named after A.I. Saltanov. 2022;(3):27-44. (In Russ.). https://doi.org/10.21320/1818-474X-2022-3-27-44
Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. British Journal of Surgery. 1991;78(3):355-360.
Prytherch DR, Whiteley MS, Higgins B, Weaver PC, Prout WG, Powell SJ. POSSUM and Portsmouth POSSUM for predicting mortality. Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity. British Journal of Surgery. 1998;85(9):1217-1220.
Ramkumar T, Ng V, Fowler L, Farouk R. A comparison of POSSUM, P-POSSUM and colorectal POSSUM for the prediction of postoperative mortality in patients undergoing colorectal resection. Diseases of the Colon & Rectum. 2006;49(3):330-335.
Tez M, Yoldaş O, Gocmen E, Külah B, Koc M. Evaluation of P-POSSUM and CR-POSSUM scores in patients with colorectal cancer undergoing resection. World Journal of Surgery. 2006;30(12):2266-2269.
Lam CM, Fan ST, Yuen AW, Law WL, Poon K. Validation of POSSUM scoring systems for audit of major hepatectomy. British Journal of Surgery. 2004;91(4):450-454.
Mohil RS, Bhatnagar D, Bahadur L, Rajneesh, Dev DK, Magan M. POSSUM and P-POSSUM for risk-adjusted audit of patients undergoing emergency laparotomy. British Journal of Surgery. 2004;91(4):500-503.
van Zeeland ML, Genovesi IP, Mulder JW, Strating PR, Glas AS, Engel AF. POSSUM predicts hospital mortality and long-term survival in patients with hip fractures. Journal of Trauma. 2011;70(4):67-72.
Chen T, Wang H, Wang H, Song Y, Li X, Wang J. POSSUM and P-POSSUM as predictors of postoperative morbidity and mortality in patients undergoing hepato-biliary-pancreatic surgery: a meta-analysis. Annals of Surgical Oncology. 2013;20(8):2501-2510.
Copeland GP. The POSSUM System of Surgical Audit. The Archives of Surgery. 2002;137(1):15-19. https://doi.org/10.1001/archsurg.137.1.15
Davies SJ, Wilson RJT. Rationalizing the use of surgical critical care: the role of cardiopulmonary exercise testing. Ed.: Vincent J-L. Yearbook of intensive care and emergency medicine. Springer. 2009;445-460.

Close metadata