Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2007

Open Access 01-12-2007 | Review

Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery

Authors: Thomas E Rix, Tom Bates

Published in: World Journal of Emergency Surgery | Issue 1/2007

Login to get access

Abstract

Background

The decision on whether to operate on a sick elderly person with an intra-abdominal emergency is one of the most difficult in general surgery. A predictive risk-score would be of great value in this situation.

Methods

A Medline search was performed to identify those predictive risk-scores relevant to sick elderly patients in whom emergency surgery might be life-saving.

Results

Many of the risk scores for surgical patients include the operative findings or require tests which are not available in the acute situation. Most of the relevant studies include younger patients and elective surgery. The Glasgow Aneurysm Score and Hardman Index are specific to ruptured aortic aneurysm while the Boey Score and the Hacetteppe Score are specific to perforated peptic ulcer. The Reiss Index and Fitness Score can be used pre-operatively if the elements of the score can be completed in time. The ASA score, which includes a significant element of subjective clinical judgement, can be augmented with factors such as age and urgency of surgery but no test has a negative predictive value sufficient to recommend against surgical intervention without clinical input.

Conclusion

Risk scores may be helpful in sick elderly patients needing emergency abdominal surgery but an experienced clinical opinion is still essential.
Literature
1.
Anon: New classification of physical status. Anesthesiology. 1963, 24: 111.
2.
Seymour DG, Pringle R: A new method of auditing surgical mortality rates: application to a group of elderly general surgical patients. BMJ. 1982, 284: 1539-42.PubMedCentralCrossRefPubMed
3.
Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B: Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977, 297: 845-50.CrossRefPubMed
4.
Kroenke K, Lawrence VA, Theroux JF, Tuley MR, Hilsenbeck S: Postoperative complications after thoracic and major abdominal surgery in patients with and without obstructive lung disease. Chest. 1993, 104: 1445-51.CrossRefPubMed
5.
Mullen JL, Gertner MH, Buzby GP, Goodhart GL, Rosato EF: Implications of malnutrition in the surgical patient. Arch Surg. 1979, 114: 121-5.CrossRefPubMed
6.
Copeland GP, Jones D, Walters M: POSSUM: a scoring system for surgical audit. Br J Surg. 1991, 78: 355-60. 10.1002/bjs.1800780327.CrossRefPubMed
7.
Prytherch DR, Whiteley MS, Higgins B, Weaver PC, Prout WG, Powell SJ: POSSUM and Portsmouth POSSUM for predicting mortality. Br J Surg. 1998, 85: 1217-1220. 10.1046/j.1365-2168.1998.00840.x.CrossRefPubMed
8.
Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE: APACHE – acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med. 1985, 13: 818-29. 10.1097/00003246-198510000-00009.CrossRefPubMed
9.
Goffi L, Saba V, Ghiselli R, Necozione S, Mattei A, Carle F: Preoperative APACHE II and ASA scores in patients having major general surgical operations: Prognostic value and potential clinical applications. Eur J Surg. 1999, 165: 730-35. 10.1080/11024159950189483.CrossRefPubMed
10.
Bergner M, Bobbitt RA, Pollard WE: Sickness Impact Profile: validation of a health status measure. Med Care. 1976, 14: 57-61. 10.1097/00005650-197601000-00006.CrossRefPubMed
11.
Reiss R, Deutsch A, Nudelman I: Surgical problems in octogenarians: epidemiological analysis of 1083 consecutive admissions. World J Surg. 1992, 16: 1017-21. 10.1007/BF02067023.CrossRefPubMed
12.
Samy AK, Murray G, MacBain G: Glasgow aneurysm score. Cardiovasc Surg. 1994, 2: 41-44.PubMed
13.
Playforth MJ, Smith GMR, Evans M, Pollock AV: Pre-operative assessment of fitness score. Br J Surg. 1987, 74: 890-2. 10.1002/bjs.1800741007.CrossRefPubMed
14.
Barlow AP, Zarifa Z, Shillito RG, Crumplin MKH, Edwards E, McCarthy JM: Surgery in a geriatric population. Ann R Coll Surg Engl. 1989, 71: 110-4.PubMedCentralPubMed
15.
Arenal JJ, Bengoechea-Beeby M: Mortality associated with emergency abdominal surgery in the elderly. Can J Surg. 2003, 46: 111-16.PubMedCentralPubMed
16.
Donati A, Ruzzi M, Adrario E, Pelaia P, Coluzzi F, Gabbanelli V, Pietropaoli P: A new and feasible model for predicting operative risk. Br J Anaesth. 2004, 93: 393-9. 10.1093/bja/aeh210.CrossRefPubMed
17.
Hall JC, Hall JL: ASA status and age predict adverse events after abdominal surgery. J Qual Clin Pract. 1996, 16: 103-8.PubMed
18.
Cook TM, Day CJE: Hospital mortality after urgent and emergency laparotomy in patients aged 65 yr and over. Risk and prediction of risk using multiple logistic regression analysis. Br J Anaesth. 1998, 80: 776-81.CrossRefPubMed
19.
Akoh JA, Mathew AM, Chalmers JWT, Finlayson A, Auld GD: Audit of major gastrointestinal surgery in patients aged 80 years or over. J R Coll Surg Edin. 1994, 39: 208-213.
20.
Makela JT, Kiviniemi H, Laitinen S: Prognostic factors of perforated sigmoid diverticulitis in the elderly. Dig Surg. 2005, 22: 100-106. 10.1159/000085472.CrossRefPubMed
21.
Wolters U, Wolf T, Stutzer H, Schroder T: ASA classification and peri-operative variables as predictors of postoperative outcome. Br J Anaesth. 1996, 77: 217-222.CrossRefPubMed
22.
Owens WD, Felts JA, Spitznagel EL: ASA physical status classifications: a study of consistency of ratings. Anaesthesiology. 1978, 49: 239-43. 10.1097/00000542-197810000-00003.CrossRef
23.
Kennedy RH, al-Mufti RA, Brewster SF, Sherry EN, Magee TR, Irvin TT: The acute surgical admission: is mortality predictable in the elderly. Ann R Coll Surg Engl. 1994, 76: 342-5.PubMedCentralPubMed
24.
Leardi S, De Santis C, Ciccarelli O, Valenti M, D'Alessandro A, Pietroletti R, Simi M: Risk of surgery in geriatric age: prospective evaluation of risk factors. Ann Ital Chir. 1998, 69: 575-9.PubMed
25.
LeGall J, Loirat P, Alperovitch A, Glaser P, Granthil C, Mathieu D: A simplified acute physiology score for ICU patients. Crit Care Med. 1984, 12: 975-977.CrossRef
26.
27.
Goris RJA, te Boekhorst TPA, Nuytinck JKS, Gimbrere JSF: Multi-organ failure. Generalized autodestructive inflammation?. Arch Surg. 1985, 120: 1109-15.CrossRefPubMed
28.
Wacha H, Linder MM, Feldman U, Wesch G, Gundlach E, Steifensand RA: Mannheim Peritonitis Index – prediction of risk of death from peritonitis: construction of a stastical and validation of an empirically based index. Theoretical Surgery. 1987, 1: 169-77.
29.
Bosscha K, Reijinders K, Hulstaert PF, Algra A, van der Werken C: Prognostic scoring systems to predict outcome in peritonitis and intra-abdominal sepsis. Br J Surg. 1997, 84: 1532-34. 10.1002/bjs.1800841110.CrossRefPubMed
30.
Qureshi AM, Zafar A, Saeed K, Quddus A: Predictive power of Mannheim Peritonitis Index. JCPSP. 2005, 11: 693-696.
31.
Jones HJS, de Cossart L: Risk scoring in surgical patients. Br J Surg. 1999, 86: 149-157. 10.1046/j.1365-2168.1999.01006.x.CrossRefPubMed
32.
Boey J, Choi SKY, Alagaratnam TT, Poon A: Risk stratification in perforated duodenal ulcers. Ann Surg. 1987, 205: 22-26. 10.1097/00000658-198701000-00005.PubMedCentralCrossRefPubMed
33.
Irvin TT: Mortality and perforated peptic ulcer: a case for risk stratification in elderly patients. Br J Surg. 1989, 76: 215-218. 10.1002/bjs.1800760304.CrossRefPubMed
34.
Altaca G, Sayek I, Onat D, Cakmakci M, Kamiloglu S: Risk factors in perforated peptic ulcer disease: comparison of a new score system with the Mannheim Peritonitis Index. Eur J Surg. 1992, 158: 217-221.PubMed
35.
Prytherch DR, Ridler BMF, Earnshaw JJ: A model for national audit in vascular surgery. Eur J Vasc Endovasc Surg. 2001, 21: 477-83. 10.1053/ejvs.2001.1369.CrossRefPubMed
36.
Neary B, Whitman B, Foy C, Heather BP, Earnshaw JJ: Value of POSSUM physiology scoring to assess outcome after intra-arterial thrombolysis for acute leg ischaemia. Br J Surg. 2001, 88: 1344-45. 10.1046/j.0007-1323.2001.01914.x.CrossRefPubMed
37.
Neary WD, Crow P, Foy C, Prytherch D, Heather BP, Earnshaw JJ: Comparison of POSSUM scoring and the Hardman Index in selection of patients for repair of ruptured abdominal aortic aneurysm. Br J Surg. 2003, 90: 421-425. 10.1002/bjs.4061.CrossRefPubMed
38.
Hardman DTA, Fisher CM, Patel MI, Neale M, Chambers J, Lane R, Appleberg M: Ruptured abdominal aortic aneurysms : who should be offered surgery?. J Vasc Surg. 1996, 23: 123-9. 10.1016/S0741-5214(05)80042-4.CrossRefPubMed
39.
Tambyraja AL, Fraser SCA, Murie JA, Chalmers RTA: Validity of the Glasgow Aneurysm Score and Hardman Index in predicting outcome after ruptured abdominal aortic aneurysm repair. Br J Surg. 2005, 92: 570-573. 10.1002/bjs.4907.CrossRefPubMed
40.
Samy AK, Murray G, MacBain G: Prospective evaluation of the Glasgow Aneurysm Score. J R Coll Surg Edin. 1996, 41: 105-107.
41.
Korhonen SJ, Ylonen K, Biancari F, Heikkinen M, Salenius JP, Lepantalo M: Glasgow Aneurysm Score as a predictor of immediate outcome after surgery for ruptured abdominal aortic aneurysm. Br J Surg. 2004, 91: 1449-1452. 10.1002/bjs.4634.CrossRefPubMed
42.
Leo E, Biancari F, Nesi F, Poqany G, Bartolucci R, De Pasquale F, Rainio P, Satta J, Rabitti G, Juvonen T: Risk-scoring methods in predicting the immediate outcome after emergency open repair of ruptured abdominal aortic aneurysm. Am J Surg. 2006, 192: 19-23. 10.1016/j.amjsurg.2006.01.026.CrossRefPubMed
43.
Fazio VW, Tekkis PP, Remzi F, Lavery IC: Assessment of operative risk in colorectal cancer surgery: the Cleveland Clinic Foundation colorectal cancer model. Dis Colon Rectum. 2004, 47: 2015-24. 10.1007/s10350-004-0704-y.CrossRefPubMed
44.
Veltkamp SC, Kemmeren JM, van der Graaf Y, Edlinger M, van der Werken C: Predicion of serious complications in patients admitted to a surgical ward. Br J Surg. 2002, 89: 94-102. 10.1046/j.0007-1323.2001.01963.x.CrossRefPubMed
45.
Arozullah AM, Daley J, Henderson WG, Khuri SF: Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. Ann Surg. 2000, 232: 242-253. 10.1097/00000658-200008000-00015.PubMedCentralCrossRefPubMed
46.
Arozullah AM, Khuri SF, Henderson WG, Daley J: Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Ann Intern Med. 2001, 135: 847-857.CrossRefPubMed
47.
Sutton R, Bann S, Brooks M, Sarin S: The Surgical Risk Scale as an improved tool for risk-adjusted analysis in comparative surgical audit. Br J Surg. 2002, 89: 763-768. 10.1046/j.1365-2168.2002.02080.x.CrossRefPubMed
48.
Brooks MJ, Sutton R, Sarin S: Comparison of Surgical Risk Score, POSSUM and p-POSSUM in higher-risk surgical patients. Br J Surg. 2005, 92: 1288-1292. 10.1002/bjs.5058.CrossRefPubMed
49.
Hartley MN, Sagar PM: The surgeon's "gut feeling" as a predictor of postoperative outcome. Ann R Coll Surg Engl. 1994, 76 (Suppl): 277-8.PubMed
50.
Cook TM, Britton DC, Craft TM, Jones CB, Horrocks M: An audit of hospital mortality after urgent and emergency surgery in the elderly. Ann R Coll Surg Engl. 1997, 79: 361-7.PubMedCentralPubMed
51.
Markus PM, Martell J, Leister I, Horstmann O, Brinker J, Becker H: Predicting post-operative morbidity by clinical assessment. Br J Surg. 2005, 92: 101-106. 10.1002/bjs.4608.CrossRefPubMed
52.
Hobson SA, Sutton CD, Garcea G, Thomas WM: Prospective comparison of POSSUM and p-POSSUM with clinical assessment of mortality following emergency surgery. Acta Anaesthesiol Scand. 2007, 51: 94-100. 10.1111/j.1399-6576.2006.01167.x.CrossRefPubMed
53.
Anwar MA, D'Souza F, Coulter R, Memon B, Khan IM, Memon MA: Outcome of acutely perforated colorectal cancers: Experience of a single district general hospital. Surg Oncol. 2006, 15: 91-96. 10.1016/j.suronc.2006.09.001.CrossRefPubMed
54.
Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R: European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999, 16: 9-13. 10.1016/S1010-7940(99)00134-7.CrossRefPubMed
55.
Nashef SA, Roques F, Hammill BG, Peterson ED, Michel P, Grover FL, Wyse RK, Ferguson TB, EuroSCORE Project Group: Validation of European System for Cardiac Operative Risk Evaluation (EuroSCORE) in North American cardiac surgery. Eur J Cardiothorac Surg. 2002, 22: 101-5. 10.1016/S1010-7940(02)00208-7.CrossRefPubMed
Metadata
Title
Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery
Authors
Thomas E Rix
Tom Bates
Publication date
01-12-2007
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2007
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/1749-7922-2-16

Other articles of this Issue 1/2007

World Journal of Emergency Surgery 1/2007 Go to the issue

Case report

Deep vein thrombosis and pulmonary embolus associated with a ruptured popliteal aneurysm – a cautionary note

Research article

Are upright lateral cervical radiographs in the obtunded trauma patient useful? A retrospective study

Research article

Dying from cardiac tamponade

Research article

Utility of esophageal gastroduodenoscopy at the time of percutaneous endoscopic gastrostomy in trauma patients

Research article

What clinical and laboratory parameters determine significant intra abdominal pathology for patients assessed in hospital with acute abdominal pain?

Research article

Regional variability in use of a novel assessment of thoracolumbar spine fractures: United States versus international surgeons