Risk scoring in surgical patients

BACKGROUND: A large number of scoring systems for assessing a patient's risk of complications or death has been developed over recent years. This is a review of those that are of relevance to general surgeons. METHODS: A Medline literature search was performed to identify all articles concerning 'severity of illness', 'morbidity', 'mortality' and 'postoperative complications' in the field of surgery from 1966 to 1997. Further searches were performed to find papers about specific identified scoring systems, and relevant articles from the reference lists of these were also sought. RESULTS AND CONCLUSION: The advantages of an accurate assessment of a patient's risk include, on an individual level, the opportunity to give a more accurate prognosis and choose the most appropriate treatment. If the risk of an adverse outcome is known for a group of patients, the actual outcome can be compared with the predicted outcome, and comparison can be made between groups in different surgical units for the purposes of audit or research. The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) is the most appropriate of the currently available scores for general surgical practice.