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Risk prediction tools for older general surgical patients

Published online by Cambridge University Press:  13 April 2015

M Middleton ,
MJ Stechman ,
S Moug ,
K McCarthy  and
J Hewitt
M Middleton
Affiliation:
School of Medicine, Cardiff University, UK
MJ Stechman
Affiliation:
University Hospital of Wales, Cardiff, UK
S Moug
Affiliation:
Royal Alexandra Hospital, Paisley, UK
K McCarthy
Affiliation:
Southmead Hospital, Bristol, UK
J Hewitt*
Affiliation:
School of Medicine, Cardiff University, UK
*
Address for correspondence: Dr Jonathan Hewitt, Department of Geriatric Medicine, 3rd Floor Academic Centre, Llandough Hospital, Penlan Road, Penarth CF64 2XX. Email: HewittJ2@cardiff.ac.uk
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Summary

This review identifies and examines the clinical application of risk prediction tools, including the American Society of Anaesthesiology (ASA) Classification System and POSSUM-based scores, in the older general surgical patient. Predicting outcomes in this patient group remains difficult; it is challenging to design a risk prediction tool that will apply to both emergency and elective surgery and that remains valid across the wide age range that this patient group encompasses. Risk prediction tools can have benefit but should be used in conjunction with the clinical assessment of those experienced in the care of this challenging patient group.

Keywords

risk predictionolder patientssurgeryemergency

Information

Type
Review Article
Information
Reviews in Clinical Gerontology , Volume 25 , Issue 1 , February 2015 , pp. 12 - 21
Copyright
Copyright © Cambridge University Press 2015 

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References

1Jones, HJ, de Cossart, L. Risk scoring in surgical patients. Br J Surg 1999; 86: 149–57.Google Scholar
2Kwok, AC, Lipsitz, SR, Bader, AM, Gawande, AA. Are targeted preoperative risk prediction tools more powerful? A test of models for emergency colon surgery in the very elderly. J Am Coll Surg 2011; 213: 220–25.Google Scholar
3Sevdalis, N, Jacklin, R. Opening the ‘black box’ of surgeons’ risk estimation: from intuition to quantitative modeling. World J Surg 2008; 32: 324–25.CrossRefGoogle ScholarPubMed
4Clavien, PA, Dindo, D. Surgeon's intuition: is it enough to assess patients’ surgical risk? World J Surg 2007; 31: 1909–11.Google Scholar
5National Confidential Enquiry into Patient Outcome and Death. An Age Old Problem: a review of the care recieved by elderly patients undergoing surgery; 2010.Google Scholar
6Dhesi, J. Peri-operative Care for Older Patients Undergoing Surgery: British Geriatrics Society; 2013.Google Scholar
7Doyle, Y, McKee, M, Sherriff, M. A model of successful ageing in British populations. Eur J Public Health 2012; 22: 71–76.Google Scholar
8Bugeja, G, Kumar, A, Banerjee, AK. Exclusion of elderly people from clinical research: a descriptive study of published reports. BMJ 1997; 315: 1059.Google Scholar
9Jacobs, JP, Mavroudis, C, Jacobs, MLet al.What is operative mortality? Defining death in a surgical registry database: a report of the STS Congenital Database Taskforce and the Joint EACTS-STS Congenital Database Committee. Ann Thorac Surg 2006; 81: 1937–41.Google Scholar
10Ugolini, G, Rosati, G, Montroni, Iet al.Can elderly patients with colorectal cancer tolerate planned surgical treatment? A practical approach to a common dilemma. Colorectal Dis 2009; 11: 750–55.Google Scholar
11Logeais, Y, Langanay, T, Roussin, Ret al.Surgery for aortic stenosis in elderly patients. A study of surgical risk and predictive factors. Circulation 1994; 90: 2891–98.Google Scholar
12Turrentine, FE, Wang, H, Simpson, VB, Jones, RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 2006; 203: 865–77.CrossRefGoogle ScholarPubMed
13Finlayson, EV, Birkmeyer, JD. Operative mortality with elective surgery in older adults. Eff Clin Pract 2001; 4: 172–77.Google Scholar
14Hurria, A. Geriatric assessment in oncology practice. J Am Geriatr Soc 2009; 57: S246–49.Google Scholar
15Janssen-Heijnen, ML, Maas, HA, Houterman, S, Lemmens, VE, Rutten, HJ, Coebergh, JW. Comorbidity in older surgical cancer patients: influence on patient care and outcome. Eur J Cancer 2007; 43: 2179–93.Google Scholar
16Rodriguez-Molinero, A, Lopez-Dieguez, M, Tabuenca, AI, de la Cruz, JJ, Banegas, JR. Physicians’ impression on the elders’ functionality influences decision making for emergency care. Am J Emerg Med 2010; 28: 757–65.Google Scholar
17Brighi, N, Balducci, L, Biasco, G. Cancer in the elderly: is it time for palliative care in geriatric oncology? J Geriatr Oncol 2014; 5: 197–203.Google Scholar
18Fried, LP, Kronmal, RA, Newman, ABet al.Risk factors for 5-year mortality in older adults: the Cardiovascular Health Study. JAMA 1998; 279: 585–92.Google Scholar
19Ozturk, E, Yilmazlar, T. Factors affecting the mortality risk in elderly patients undergoing surgery. ANZ J Surg 2007; 77: 156–59.Google Scholar
20Fried, LP, Tangen, CM, Walston, Jet al.Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–56.Google Scholar
21Rockwood, K. What would make a definition of frailty successful? Age Ageing 2005; 34: 432–34.Google Scholar
22Partridge, JS, Harari, D, Dhesi, JK. Frailty in the older surgical patient: a review. Age Ageing 2012; 41: 142–47.Google Scholar
23Makary, MA, Segev, DL, Pronovost, PJet al.Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 2010; 210: 901–8.Google Scholar
24Hewitt, J, Stechman, M, Moug, S, Middleton, M, Chakrabarti, M. Prevalence of frailty: its association with mortality in general surgery. Am J Surg. doi: 10.1016/j.amjsurg.2014.05.022Google Scholar
25Kim, SW, Han, HS, Jung, HWet al.Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA Surg 2014; 149: 633–40.Google Scholar
26Saklad, M. Grading of patients for surgical procedures. Anesthesiology 1941; 2: 281–84.Google Scholar
27Dripps, RD, Lamont, A, Eckenhoff, JE. The role of anesthesia in surgical mortality. JAMA 1961; 178: 261–66.Google Scholar
28Klotz, HP, Candinas, D, Platz, Aet al.Preoperative risk assessment in elective general surgery. Br J Surg 1996; 83: 1788–91.Google Scholar
29Cook, TM, Day, CJ. Hospital mortality after urgent and emergency laparotomy in patients aged 65 yr and over. Risk and prediction of risk using multiple logistic regression analysis. Br J Anaesth 1998; 80: 776–81.Google Scholar
30Tekkis, PP, Poloniecki, JD, Thompson, MR, Stamatakis, JD. Operative mortality in colorectal cancer: prospective national study. BMJ 2003; 327: 1196–201.Google Scholar
31Polanczyk, CA, Marcantonio, E, Goldman, Let al.Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med 2001; 134: 637–43.Google Scholar
32Hamel, MB, Henderson, WG, Khuri, SF, Daley, J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc 2005; 53: 424–29.Google Scholar
33Leung, JM, Dzankic, S. Relative importance of preoperative health status versus intraoperative factors in predicting postoperative adverse outcomes in geriatric surgical patients. J Am Geriatr Soc 2001; 49: 1080–85.Google Scholar
34Sokol, DK, Wilson, J. What is a surgical complication? World J Surg 2008; 32: 942–44.Google Scholar
35Rampersaud, YR, Moro, ER, Neary, MAet al.Intraoperative adverse events and related postoperative complications in spine surgery: implications for enhancing patient safety founded on evidence-based protocols. Spine 2006; 31: 1503–10.Google Scholar
36Mak, PH, Campbell, RC, Irwin, MG, American Society of Anesthesiologists. The ASA Physical Status Classification: inter-observer consistency. Anaesth Intens Care 2002; 30: 633–40.CrossRefGoogle ScholarPubMed
37Barnett, S, Moonesinghe, SR. Clinical risk scores to guide perioperative management. Postgrad Med J 2011; 87: 535–41.Google Scholar
38Edwards, AE, Seymour, DG, McCarthy, JM, Crumplin, MK. A 5-year survival study of general surgical patients aged 65 years and over. Anaesthesia 1996; 51: 3–10.Google Scholar
39Bufalari, A, Ferri, M, Cao, P, Cirocchi, R, Bisacci, R, Moggi, L. Surgical care in octogenarians. Br J Surg 1996; 83: 1783–87.CrossRefGoogle ScholarPubMed
40Sutton, R, Bann, S, Brooks, M, Sarin, S. The Surgical Risk Scale as an improved tool for risk-adjusted analysis in comparative surgical audit. Br J Surg 2002; 89: 763–68.Google Scholar
41Reiss, R, Deutsch, A, Nudelman, I. Surgical problems in octogenarians: epidemiological analysis of 1,083 consecutive admissions. World J Surg 1992; 16: 1017–20.Google Scholar
42Reiss, R, Haddad, M, Deutsch, A, Lilos, P, Fuchs, C. Prognostic index: prediction of operative mortality in geriatric patients by use of stepwise logistic regression analysis. World J Surg 1987; 11: 248–51.Google Scholar
43Leardi, S, De Santis, C, Ciuca, B, Risetti, A, Pietroletti, R, Simi, M. Risk indices in geriatric surgery: ASA index versus Reiss index. Minerva Chir 1997; 52: 255–60.Google Scholar
44Copeland, GP, Jones, D, Walters, M. POSSUM: a scoring system for surgical audit. Br J Surg 1991; 78: 355–60.Google Scholar
45Whiteley, MS, Prytherch, DR, Higgins, B, Weaver, PC, Prout, WG. An evaluation of the POSSUM surgical scoring system. Br J Surg 1996; 83: 812–15.Google Scholar
46Prytherch, 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. Br J Surg 1998; 85: 1217–20.Google Scholar
47Tekkis, PP, Kessaris, N, Kocher, HM, Poloniecki, JD, Lyttle, J, Windsor, AC. Evaluation of POSSUM and P-POSSUM scoring systems in patients undergoing colorectal surgery. Br J Surg 2003; 90: 340–45.Google Scholar
48Tran Ba Loc, P, du Montcel, ST, Duron, JJet al.Elderly POSSUM, a dedicated score for prediction of mortality and morbidity after major colorectal surgery in older patients. Br J Surg 2010; 97: 396–403.Google Scholar
49Prytherch, DR, Sirl, JS, Weaver, PC, Schmidt, P, Higgins, B, Sutton, GL. Towards a national clinical minimum data set for general surgery. Br J Surg 2003; 90: 1300–5.Google Scholar
50Nichols, KG, Prytherch, DR, Fancourt, MF, Gilkison, WT, Kyle, SM, Mosquera, DA. Risk-adjusted general surgical audit in octogenarians. ANZ J Surg 2008; 78: 990–94.Google Scholar
51Munro, J, Booth, A, Nicholl, J. Routine preoperative testing: a systematic review of the evidence. Health Technol Assess 1997; 1: 1–62.Google Scholar
52Moyes, LH, Leitch, EF, McKee, RF, Anderson, JH, Horgan, PG, McMillan, DC. Preoperative systemic inflammation predicts postoperative infectious complications in patients undergoing curative resection for colorectal cancer. Br J Cancer 2009; 100: 1236–39.Google Scholar
53Kennedy, RH, al-Mufti, RA, Brewster, SF, Sherry, EN, Magee, TR, Irvin, TT. The acute surgical admission: is mortality predictable in the elderly? Ann R Coll Surg Engl 1994; 76: 342–45.Google Scholar
54Vandromme, MJ, Griffin, RL, Weinberg, JA, Rue, LW 3rd, Kerby, JD. Lactate is a better predictor than systolic blood pressure for determining blood requirement and mortality: could prehospital measures improve trauma triage? J Am Coll Surg 2010; 210: 861–69.Google Scholar
55Hasler, RM, Nuesch, E, Juni, P, Bouamra, O, Exadaktylos, AK, Lecky, F. Systolic blood pressure below 110 mmHg is associated with increased mortality in penetrating major trauma patients: multicentre cohort study. Resuscitation 2012; 83: 476–81.Google Scholar