title: Risk stratification tools for predicting morbidity and mortality in adult patients undergoing major surgery: qualitative systematic review.
abstract: Risk stratification is essential for both clinical risk prediction and comparative audit. There are a variety of risk stratification tools available for use in major noncardiac surgery, but their discrimination and calibration have not previously been systematically reviewed in heterogeneous patient cohorts.Embase, MEDLINE, and Web of Science were searched for studies published between January 1, 1980 and August 6, 2011 in adult patients undergoing major noncardiac, nonneurological surgery. Twenty-seven studies evaluating 34 risk stratification tools were identified which met inclusion criteria. The Portsmouth-Physiology and Operative Severity Score for the enUmeration of Mortality and the Surgical Risk Scale were demonstrated to be the most consistently accurate tools that have been validated in multiple studies; however, both have limitations. Future work should focus on further evaluation of these and other parsimonious risk predictors, including validation in international cohorts. There is also a need for studies examining the impact that the use of these tools has on clinical decision making and patient outcome.
authors.affiliation: * Director, University College London, University College London Hospitals' Surgical Outcomes Research Center, London, United Kingdom; Honorary Senior Lecturer, University College London; and Consultant, Anaesthesia and Critical Care, University College Hospital. † Professor, Smiths Medical Professor of Anaesthesia and Critical Care, University College London; and Honorary Consultant, Anaesthesia, University College Hospital. ‡ Research Fellow, University College London, University College London Hospitals' Surgical Outcomes Research Center, University College Hospital. § Professor and Director, Intensive Care National Audit and Research Center, London, United Kingdom. ‖ Professor of Critical Care Medicine, University of Southampton, Southampton, United Kingdom; Honorary Consultant, Critical Care, Southampton University Hospital; and Director, National Institute for Academic Anaesthesia's Health Services Research Center, London, United Kingdom.
authors.forename: Suneetha Ramani
authors.initials: SR
authors.lastname: Moonesinghe
authors.forename: Michael G
authors.initials: MG
authors.lastname: Mythen
authors.forename: Priya
authors.initials: P
authors.lastname: Das
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rowan
authors.forename: Michael P W
authors.initials: MP
authors.lastname: Grocott
mesh_terms: D000328:Adult; D003661:Decision Support Techniques; D006801:Humans; D011183:Postoperative Complications / Q000401:mortality; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000706:statistics & numerical data*; D016896:Treatment Outcome