title: Risk stratification scores in elective open abdominal aortic aneurysm repair: are they suitable for preoperative decision making?
abstract: OBJECTIVE
  Risk indices help quantify the risk of cardiovascular events and death prior to making decisions about prophylactic AAA repair. This paper aims to study the predictive capabilities of 5 validated indices.
  
  
  METHODS
  A prospective observational multi-centre cohort study from August 2005 to September 2007 in Glasgow recruited 106 consecutive patients undergoing elective open AAA repair. The Glasgow Aneurysm Score (GAS), Vascular physiology only Physiological and Operative Severity Score for enUmeration of Mortality (V(p)-POSSUM), Vascular Biochemical and Haematological Outcome Model (VBHOM), Revised Cardiac Risk Index (RCRI) and Preoperative Risk Score of the Estimation of Physiological Ability and Surgical Stress Score (PRS of E-PASS) were calculated. Indices were compared using receiver operating characteristic (ROC) analysis and area under the curve (AUC) estimates. End points were all-cause mortality, Major Adverse Cardiac Events (MACE) and cardiac death.
  
  
  RESULTS
  GAS, VBHOM and RCRI did not predict outcome. V(p)-POSSUM predicted MACE (AUC = 0.681), cardiac death (AUC = 0.762) and all-cause mortality (AUC = 0.780), as did E-PASS (AUC = 0.682, 0.821, 0.703 for MACE, cardiac death and all-cause mortality respectively).
  
  
  CONCLUSIONS
  Whilst V(p)-POSSUM and E-PASS predicted outcome, the less complex RCRI and GAS performed poorly which questions the utility of decision making based on these surgical risk indices.
authors.affiliation: Department of Vascular Surgery, Western infirmary, Dumbarton Road, Glasgow G11 6NT, UK. gavin.bryce@hotmail.com
authors.forename: G J
authors.initials: GJ
authors.lastname: Bryce
authors.forename: C J
authors.initials: CJ
authors.lastname: Payne
authors.forename: S C
authors.initials: SC
authors.lastname: Gibson
authors.forename: D B
authors.initials: DB
authors.lastname: Kingsmore
authors.forename: D S
authors.initials: DS
authors.lastname: Byrne
authors.forename: C
authors.initials: C
authors.lastname: Delles
mesh_terms: D002423:Cause of Death / Q000639:trends; D003657:Decision Making; D017558:Elective Surgical Procedures; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007813:Laparotomy; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000401:mortality