title: Comparison of Risk Scoring Systems to Predict the Outcome in ASA-PS V Patients Undergoing Surgery: A Retrospective Cohort Study.
abstract: Operative decision in American Society of Anesthesiology Physical Status (ASA-PS) V patient is difficult as this group of patients expected to have high mortality rate. Another risk scoring system in this ASA-PS V subset of patients can aid to ease this decision. Data of ASA-PS V classified patients between 2011 and 2013 years in a single hospital were analyzed in this study. Predicted mortality of these patients was determined with acute physiology and chronic health evaluations (APACHE) II, simplified acute physiology score (SAPS II), Charlson comorbidity index (CCI), Porthsmouth physiological and operative severity score for enumeration of mortality and morbidity (P-POSSUM), Surgical apgar score (SAS), and Goldman cardiac risk index (GCRI) scores. Observed and predicted mortality rates according to the risk indexes in these patients were compared at survivor and nonsurvivor group of patients. Risk stratification was made with receiver operator characteristic (ROC) curve analysis. Data of 89 patients were included in the analyses. Predicted mortality rates generated by APACHE II and SAPS II scoring systems were significantly different between survivor and nonsurvivor group of patients. Risk stratification with ROC analysis revealed that area under curve was 0.784 and 0.681 for SAPS II and APACHE II scoring systems, respectively. Highest sensitivity (77.3) is reached with SAPS II score. APACHE II and SAPS II are better predictive tools of mortality in ASA-PS V classified subset of patients. Discrimination power of SAPS II score is the best among the compared risk stratification scores. SAPS II can be suggested as an additional risk scoring system for ASA-PS V patients.
authors.affiliation: From the Anesthesiology and Reanimation Department, İzmir Atatürk Education and Research Hospital, İzmir, Turkey.
authors.forename: Derya Arslan
authors.initials: DA
authors.lastname: Yurtlu
authors.forename: Murat
authors.initials: M
authors.lastname: Aksun
authors.forename: Pnar
authors.initials: P
authors.lastname: Ayvat
authors.forename: Nagihan
authors.initials: N
authors.lastname: Karahan
authors.forename: Lale
authors.initials: L
authors.lastname: Koroglu
authors.forename: Gülcin Önder
authors.initials: GÖ
authors.lastname: Aran
mesh_terms: D018806:APACHE; D000367:Age Factors; D015897:Comorbidity; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013514:Surgical Procedures, Operative / Q000401:mortality*