Comparison of Risk Scoring Systems to Predict the Outcome in ASA-PS V Patients Undergoing Surgery: A Retrospective Cohort Study

Derya Arslan Yurtlu, Murat Aksun, Pnar Ayvat, Nagihan Karahan, Lale Koroglu, Gülcin Önder Aran, Derya Arslan Yurtlu, Murat Aksun, Pnar Ayvat, Nagihan Karahan, Lale Koroglu, Gülcin Önder Aran

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.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Receiver operator characteristic analysis results for predicted mortality rates of SAPS II, APACHE II, CCI, P POSSUM, and SAS scores.

References

    1. Cuvillon P, Nouvellon E, Marret E, et al. American Society of Anesthesiologists’ Physical Statussystem: a multicentre Francophone study to analyse reasons for classification disagreement. Eur J Anaesthesiol 2011; 28:742–747.
    1. Lupei MI, Chipman JG, Beilman GJ, et al. The association between ASA status and other risk stratification models on postoperative intensive care unit outcomes. Anesth Analg 2014; 118:989–994.
    1. Sidi A, Lobato EB, Cohen JA. The american society of anesthesiologists’ physical status: category. V revisited J Clin Anesth 2000; 12:328–334.
    1. Vacanti CJ, VanHouten RJ, Hill RC. A statistical analysis of the relationship of physical status to postoperative mortality in 68,388 cases. Anesth Analg 1970; 49:564–566.
    1. Marx GF, Mateo CV, Orkin LR. Computer analysis of postanesthetic death. Anesthesiology 1973; 39:54–58.
    1. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13:818–829.
    1. Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993; 270:2957–2963.
    1. Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg 1991; 78:355–360.
    1. Gawande AA, Kwaan MR, Regenbogen SE, et al. An apgar score for surgery. J Am Coll Surg 2007; 204:201–208.
    1. Prause G, Ratzenhofer-Comenda B, Pierer G, et al. Can ASA grade or goldman's cardiac risk index predict peri-operative mortality? A study of 16 227 patients. Anaesthesia 1997; 52:203–206.
    1. Whitmore RG, Stephen JH, Vernick C, et al. ASA grade and charlson comorbidity Index of spinal surgery patients: correlation with complications and societal cos. Spine J 2014; 14:31–38.
    1. Goertz O, Gharagozlou AF, Hirsch T, et al. A long-term comparison of a routine laboratory parameter-based severity score with APACHE II and SAPS II. J Trauma 2011; 71:1835–1840.
    1. Horwood J, Ratnam S, Maw A. Decisions to operate: the ASA grade 5 dilemma. Ann R Coll Surg Engl 2011; 93:365–369.
    1. Koperna T, Semmler D, Marian F. Risk stratification in emergency surgical patients: is the APACHE II score a reliable marker of physiological impairment? Arch Surg 2001; 136:55–59.
    1. Garcea G, Ganga R, Neal CP, et al. Preoperative early warning scores can predict in-hospital mortality and critical care admission following emergency surgery. J Surg Res 2010; 159:729–734.
    1. Sakr Y, Krauss C, Amaral AC, et al. Comparison of the performance of SAPS II, SAPS 3, APACHE II, and their customized prognostic models in a surgical intensive care unit. Br J Anaesth 2008; 101:798–803.
    1. Livingston BM, MacKirdy FN, Howie JC, et al. Assessment of the performance of five intensive care scoring models within a large scottish database. Crit Care Med 2000; 28:1820–1827.
    1. Haq A, Patil S, Parcells AL, et al. The simplified acute physiology score III is superior to the simplified acute physiology score II and acute physiology and chronic health evaluation II in predicting surgical and Icu mortality in the “oldest old”. Curr Gerontol Geriatr Res 2014; 2014:934852.doi: 10.1155/2014/934852.
    1. Mohil RS, Bhatnagar D, Bahadur L, et al. POSSUM and P-POSSUM for risk-adjusted audit of patients undergoing emergency laparotomy. Br J Surg 2004; 91:500–503.
    1. Mercer S, Guha A, Ramesh V. The P-POSSUM scoring systems for predicting the mortality of neurosurgical patients undergoing craniotomy: further validation of usefulness and application across healthcare systems. Indian J Anaesth 2013; 57:587–591.
    1. Can MF, Yagci G, Tufan T, et al. Can SAPS II predict operative mortality more accurately than POSSUM and P-POSSUM in patients with colorectal carcinoma undergoing resection? World J Surg 2008; 32:589–595.
    1. Seak CJ, Ng CJ, Yen DH, et al. Performance assessment of the Simplified Acute Physiology Score II, the Acute Physiology and Chronic Health Evaluation II score, and the Sequential Organ Failure Assessment score in predicting the outcomes of adult patients with hepatic portal venous gas in the ED. Am J Emerg Med 2014; 32:1481–1484.
    1. Gilani MT, Razavi M, Azad AM. A comparison of simplified acute physiology score II,acute physiology and chronic health evaluation II and acute physiology and chronic health evaluation III scoring system in predicting mortality and length of stay at surgical intensive care unit. Niger Med J 2014; 55:144–147.
    1. O’Dair GN, Leaper DJ. Sequential physiology scoring facilitates objective assessment of resuscitation in patients with an intra-abdominal emergency. Br J Surg 2003; 90:1445–1450.
    1. Pantoja Muñoz HJ, Fernández Ramos H, Guevara Tovar WL. Sensitivity, specificity and predictive values of the goldman, detsky and Lee cardiac indices. Rev Colomb Anestesiol 2014; 42:184–191.
    1. Tan WP, Talbott VA, Leong QQ, et al. American society of anesthesiologists class and charlson's comorbidity index as predictors of postoperative colorectal anastomotic leak: a single-institution experience. J Surg Res 2013; 184:115–119.
    1. Regenbogen SE, Ehrenfeld JM, Lipsitz SR, et al. Utility of the surgical apgar score: validation in 4119 patients. Arch Surg 2009; 144:30–36.
    1. Haynes AB, Regenbogen SE, Weiser TG, et al. Surgical outcome measurement for a global patient population: validation of the surgical apgar score in 8 countries. Surgery 2011; 149:519–524.
    1. Sobol JB, Gershengorn HB, Wunsch H, et al. The surgical apgar score is strongly associated with intensive care unit admission after high-risk intraabdominal surgery. Anesth Analg 2013; 117:438–446.

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