What is the clinical evidence from this study?

Study design: Cohort. Population: elective general surgery (n=3250). Intervention: Preoperative risk scoring system vs. ASA classification alone. Primary outcome: postoperative systemic complications (p=<0.05).

What does this research mean for the field?

A preoperative risk score using operative severity, ASA grade, respiratory disease, and malignancy predicts postoperative systemic complication rates of 5.0%, 17.9%, and 33.3% across risk tiers, identifying high-risk patients more effectively than the ASA classification alone. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

December 1, 1996Open Access

Preoperative risk assessment in elective general surgery

Q: What are the key findings of this study?

A preoperative risk score using operative severity, ASA grade, respiratory disease, and malignancy predicted postoperative systemic complication rates of 5.0%, 17.9%, and 33.3% across risk tiers.

Q: What does this research mean for the field?

A preoperative risk score using operative severity, ASA grade, respiratory disease, and malignancy predicts postoperative systemic complication rates of 5.0%, 17.9%, and 33.3% across risk tiers, identifying high-risk patients more effectively than the ASA classification alone. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

A preoperative risk score using operative severity, ASA grade, respiratory disease, and malignancy predicted postoperative systemic complication rates of 5.0%, 17.9%, and 33.3% across risk tiers.

Study Design

Type

Cohort (n=3,250)

Structured PICO

Does a preoperative risk scoring system predict postoperative systemic complications better than ASA classification alone in patients undergoing elective general surgery?

Population

3250 patients undergoing elective general surgery

Intervention

Preoperative risk scoring system based on severity of operative procedure, ASA grade, symptoms of respiratory disease, and malignancy

Comparator

ASA classification alone

Outcome

Postoperative systemic complicationscomposite

A simple 4-variable preoperative risk score can effectively stratify patients undergoing elective general surgery into risk categories for postoperative systemic complications.

Main Result

p-value: p=<0.05

Abstract

Despite improved surgical techniques there is still a risk of mortality in elective general surgery. In a prospective study preoperative data from 3250 patients were collected and compared with postoperative systemic complications, using univariate chi 2 analysis. Highly significant (P < 0.00001) variables were subjected to stepwise logistic regression analysis. The severity of operative procedure, higher American Society of Anesthesiologists (ASA) grade, symptoms of respiratory disease and malignancy were found to be significant risk factors predicting postoperative morbidity (P < 0.05). Using these four variables, a simple preoperative risk scoring system has been defined. Class A (up to 5 points) was defined as a low-risk group (systemic complication rate 5.0 per cent), class B (5-7 points) was intermediate risk (systemic complication rate 17.9 per cent) and class C (8-10 points) was high risk (systemic complication rate 33.3 per cent). Patients at high risk for perioperative and postoperative complications are more likely to be identified by this analysis than by using the ASA classification alone.

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