The risk of mortality and morbidity could be accurately estimated using perioperative risk score systems

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Abstract Context According to national guidelines, a mortality risk assessment should be performed on all patients undergoing emergency surgery at the time of admission. This will allow the hospital to assign the "high-risk" patient the proper seniority and level of care. Our goal was to determine whether perioperative risk scoring systems could reliably estimate the risk of death and morbidity. Methods 86 consecutive emergency laparotomies had their mortality risk scores determined using pre-operative risk calculation techniques (ASA, Lee index) and post-operative risk calculation tools (POSSUM, P-POSSUM, and CR-POSSUM). Using the Clavien-Dindo classification, morbidity risk scores were computed using the POSSUM projected morbidity and compared to actual morbidity. Results In reality, the death rate was 10.5%. All laparotomies had average predicted risk scores of 26.5% for ASA, 2.5% for Lee Index, 29.5% for POSSUM, 18.5% for P-POSSUM, and 10.5% for CR-POSSUM. Seventy-eight percent of the 67 laparotomies had complications. Most (51%) of the problems were categorized as non-life-threatening in Clavien-Dindo grades 2–3. Compared to patients who projected a morbidity risk of less than or equal to 50%, patients with a POSSUM morbidity risk of greater than 50% suffered significantly more life-threatening complications (CD 4-5) (P = 0.01). Summary Because the ASA overpredicts mortality risk and the Lee Index underpredicts it, pre-operative risk categorization is still difficult. We propose that patients who need intensive care after surgery can be identified with greater accuracy by utilizing the CR-POSSUM for post-operative risk grading. In conclusion It is impossible to audit the fulfillment of national standards of care for the "high-risk" patient in a reliable manner in the absence of reliable risk scoring instruments that can be utilized at the time of hospital admission.

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