Simplified risk stratification in elective colorectal surgery

ANZ Journal of Surgery
Thomas A BowlesDavid A Watters

Abstract

Audit is a compulsory part of practice and all outcomes are now scrutinized. Raw results may be used to compare performance but these may not accurately reflect case and patient mix. Risk stratification tools, such as American Society of Anaesthesiologists (ASA) and Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), have been shown to predict morbidity and mortality at the expense of extra data collection. The Special Cooperative Audit of Rural Surgeons reported that two comorbidities increased mortality from 4% to 16, but this finding has not been confirmed. Our aim was to compare risk stratification tools and confirm or refute if comorbidities are accurate predictors of morbidity and mortality. We made use of an existing colorectal audit, which includes ASA, POSSUM, comorbidities and surgical outcomes. Our anaesthetic department provided data from preoperative cardiopulmonary exercise tests. A poor surgical outcome was defined as death, anastomotic leak and a complication requiring significant intervention. Data collection was complete for comorbidities, but only 79% cases had ASA scores, 72% completed POSSUM sets and 39% anaerobic threshold. POSSUM >30, ASA III and two comorbi...Continue Reading

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Citations

Jan 29, 2010·Surgery Today·Siyamek Neragi-MiandoabChristopher Mills
Nov 4, 2010·Surgery Today·Kok-Yang TanPhyllis Tan
Jan 23, 2009·The British Journal of Surgery·P O HendryUNKNOWN Enhanced Recovery After Surgery Study Group
Feb 3, 2012·ANZ Journal of Surgery·Nicholas K NguiGrahame Ctercteko
Feb 4, 2010·Journal of the American Geriatrics Society·Naseem MirbagheriDavid A K Watters
Apr 1, 2015·ANZ Journal of Surgery·Cherng Huei KongDavid A Watters
May 17, 2019·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·J van DellenA B Williams
Jul 3, 2009·Diseases of the Colon and Rectum·Joseph L RaggGlenn D Guest

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