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Risk prediction tools for older general surgical patients

  • M Middleton (a1), MJ Stechman (a2), S Moug (a3), K McCarthy (a4) and J Hewitt (a1)...
Summary
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.

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Corresponding author
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
References
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1Jones HJ, de Cossart L. Risk scoring in surgical patients. Br J Surg 1999; 86: 149–57.
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.
3Sevdalis N, Jacklin R. Opening the ‘black box’ of surgeons’ risk estimation: from intuition to quantitative modeling. World J Surg 2008; 32: 324–25.
4Clavien PA, Dindo D. Surgeon's intuition: is it enough to assess patients’ surgical risk? World J Surg 2007; 31: 1909–11.
5National Confidential Enquiry into Patient Outcome and Death. An Age Old Problem: a review of the care recieved by elderly patients undergoing surgery; 2010.
6Dhesi J. Peri-operative Care for Older Patients Undergoing Surgery: British Geriatrics Society; 2013.
7Doyle Y, McKee M, Sherriff M. A model of successful ageing in British populations. Eur J Public Health 2012; 22: 7176.
8Bugeja G, Kumar A, Banerjee AK. Exclusion of elderly people from clinical research: a descriptive study of published reports. BMJ 1997; 315: 1059.
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.
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.
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.
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.
13Finlayson EV, Birkmeyer JD. Operative mortality with elective surgery in older adults. Eff Clin Pract 2001; 4: 172–77.
14Hurria A. Geriatric assessment in oncology practice. J Am Geriatr Soc 2009; 57: S24649.
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.
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.
17Brighi N, Balducci L, Biasco G. Cancer in the elderly: is it time for palliative care in geriatric oncology? J Geriatr Oncol 2014; 5: 197203.
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.
19Ozturk E, Yilmazlar T. Factors affecting the mortality risk in elderly patients undergoing surgery. ANZ J Surg 2007; 77: 156–59.
20Fried LP, Tangen CM, Walston Jet al.Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M14656.
21Rockwood K. What would make a definition of frailty successful? Age Ageing 2005; 34: 432–34.
22Partridge JS, Harari D, Dhesi JK. Frailty in the older surgical patient: a review. Age Ageing 2012; 41: 142–47.
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.
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.2014.05.022
25Kim SW, Han HS, Jung HWet al.Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA Surg 2014; 149: 633–40.
26Saklad M. Grading of patients for surgical procedures. Anesthesiology 1941; 2: 281–84.
27Dripps RD, Lamont A, Eckenhoff JE. The role of anesthesia in surgical mortality. JAMA 1961; 178: 261–66.
28Klotz HP, Candinas D, Platz Aet al.Preoperative risk assessment in elective general surgery. Br J Surg 1996; 83: 1788–91.
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.
30Tekkis PP, Poloniecki JD, Thompson MR, Stamatakis JD. Operative mortality in colorectal cancer: prospective national study. BMJ 2003; 327: 1196–201.
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.
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.
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.
34Sokol DK, Wilson J. What is a surgical complication? World J Surg 2008; 32: 942–44.
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.
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.
37Barnett S, Moonesinghe SR. Clinical risk scores to guide perioperative management. Postgrad Med J 2011; 87: 535–41.
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: 310.
39Bufalari A, Ferri M, Cao P, Cirocchi R, Bisacci R, Moggi L. Surgical care in octogenarians. Br J Surg 1996; 83: 1783–87.
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.
41Reiss R, Deutsch A, Nudelman I. Surgical problems in octogenarians: epidemiological analysis of 1,083 consecutive admissions. World J Surg 1992; 16: 1017–20.
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.
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.
44Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg 1991; 78: 355–60.
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.
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.
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.
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: 396403.
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.
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.
51Munro J, Booth A, Nicholl J. Routine preoperative testing: a systematic review of the evidence. Health Technol Assess 1997; 1: 162.
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.
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.
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.
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.
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Reviews in Clinical Gerontology
  • ISSN: 0959-2598
  • EISSN: 1469-9036
  • URL: /core/journals/reviews-in-clinical-gerontology
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