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New surgical scoring system to predict postoperative mortality
PURPOSE: There is still no easy and highly useful method to comprehensively assess both preoperative and intraoperative patient statuses to predict postoperative outcomes. We attempted to develop a new scoring system that would enable a comprehensive assessment of preoperative and intraoperative pat...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Japan
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378752/ https://www.ncbi.nlm.nih.gov/pubmed/27995328 http://dx.doi.org/10.1007/s00540-016-2290-2 |
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author | Kinoshita, Maho Morioka, Nobutada Yabuuchi, Mariko Ozaki, Makoto |
author_facet | Kinoshita, Maho Morioka, Nobutada Yabuuchi, Mariko Ozaki, Makoto |
author_sort | Kinoshita, Maho |
collection | PubMed |
description | PURPOSE: There is still no easy and highly useful method to comprehensively assess both preoperative and intraoperative patient statuses to predict postoperative outcomes. We attempted to develop a new scoring system that would enable a comprehensive assessment of preoperative and intraoperative patient statuses instantly at the end of anesthesia, predicting postoperative mortality. METHODS: The study included 32,555 patients who underwent surgery under general or regional anesthesia from 2008 to 2012. From the anesthesia records, extracted factors, including patient characteristics and American Society of Anesthesiologists physical status classification (ASA-PS), and three intraoperative indexes (the lowest heart rate, lowest mean arterial pressure, and estimated volume of blood loss) are used to calculate the surgical Apgar score (sAs). The sAs and ASA-PS, and surgical Apgar score combined with American Society of Anesthesiologists physical status classification (SASA), which combines the sAs and ASA-PS into a single adjusted scale, were compared and analyzed with postoperative 30-day mortality. RESULTS: Increased severity of the sAs, ASA-PS and SASA was correlated with significantly higher mortality. The risk of death was elevated by 3.65 for every 2-point decrease in the sAs, by 6.4 for every 1-point increase in the ASA-PS, and by 9.56 for every 4-point decrease in the SASA. The ROC curves of the sAs and ASA-PS alone also individually demonstrated high validity (AUC = 0.81 for sAs and 0.79 for ASA-PS, P < 0.001). The SASA was even more valid (AUC = 0.87, P < 0.001). CONCLUSIONS: The sAs and ASA-PS were shown to be extremely useful for predicting 30-day mortality after surgery. An even higher predictive ability was demonstrated by the SASA, which combines these simple and effective scoring systems. |
format | Online Article Text |
id | pubmed-5378752 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Springer Japan |
record_format | MEDLINE/PubMed |
spelling | pubmed-53787522017-04-17 New surgical scoring system to predict postoperative mortality Kinoshita, Maho Morioka, Nobutada Yabuuchi, Mariko Ozaki, Makoto J Anesth Original Article PURPOSE: There is still no easy and highly useful method to comprehensively assess both preoperative and intraoperative patient statuses to predict postoperative outcomes. We attempted to develop a new scoring system that would enable a comprehensive assessment of preoperative and intraoperative patient statuses instantly at the end of anesthesia, predicting postoperative mortality. METHODS: The study included 32,555 patients who underwent surgery under general or regional anesthesia from 2008 to 2012. From the anesthesia records, extracted factors, including patient characteristics and American Society of Anesthesiologists physical status classification (ASA-PS), and three intraoperative indexes (the lowest heart rate, lowest mean arterial pressure, and estimated volume of blood loss) are used to calculate the surgical Apgar score (sAs). The sAs and ASA-PS, and surgical Apgar score combined with American Society of Anesthesiologists physical status classification (SASA), which combines the sAs and ASA-PS into a single adjusted scale, were compared and analyzed with postoperative 30-day mortality. RESULTS: Increased severity of the sAs, ASA-PS and SASA was correlated with significantly higher mortality. The risk of death was elevated by 3.65 for every 2-point decrease in the sAs, by 6.4 for every 1-point increase in the ASA-PS, and by 9.56 for every 4-point decrease in the SASA. The ROC curves of the sAs and ASA-PS alone also individually demonstrated high validity (AUC = 0.81 for sAs and 0.79 for ASA-PS, P < 0.001). The SASA was even more valid (AUC = 0.87, P < 0.001). CONCLUSIONS: The sAs and ASA-PS were shown to be extremely useful for predicting 30-day mortality after surgery. An even higher predictive ability was demonstrated by the SASA, which combines these simple and effective scoring systems. Springer Japan 2016-12-19 2017 /pmc/articles/PMC5378752/ /pubmed/27995328 http://dx.doi.org/10.1007/s00540-016-2290-2 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Article Kinoshita, Maho Morioka, Nobutada Yabuuchi, Mariko Ozaki, Makoto New surgical scoring system to predict postoperative mortality |
title | New surgical scoring system to predict postoperative mortality |
title_full | New surgical scoring system to predict postoperative mortality |
title_fullStr | New surgical scoring system to predict postoperative mortality |
title_full_unstemmed | New surgical scoring system to predict postoperative mortality |
title_short | New surgical scoring system to predict postoperative mortality |
title_sort | new surgical scoring system to predict postoperative mortality |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378752/ https://www.ncbi.nlm.nih.gov/pubmed/27995328 http://dx.doi.org/10.1007/s00540-016-2290-2 |
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