Risk stratification in major surgery

Risk stratification tools for predicting morbidity and mortality in adult patients undergoing major surgery: qualitative systematic review

What was this review about? 

Risk stratification is essential for both clinical risk predication and comparative audit. There are a variety of risk stratification tools available for use in major non-cardiac surgery, but their discrimination and calibration have not previously been systematically reviewed. 

This review looked at studies that validated risk stratification tools in groups of adult patients undergoing surgery that included at least two surgical subspecialties. The purpose of the review was to report and summarise the discrimination and calibration of the risk stratification tools. 

What did the review find? 

The review identified 27 eligible studies evaluating 31 risk stratification tools.

A large number of tools had been developed and validated in single studies, which limited any assessment of their usefulness and generalisability. 

A smaller number of tools had been validated multiple times and could be used for perioperative risk prediction. 

Of these, the P-POSSUM and Surgical Risk Scale had been demonstrated to be the most consistently accurate systems. Both have limitations. 

The authors recommended that future work should focus on further evaluation of these and other parsimonious risk predictors, including validation in international cohorts. There was also a need for studies examining the impact that the use of these tools has on clinical decision-making and patient outcome. 

Publication

  • Authors: Moonesinghe SR, Mythen MG, Das P, Rowan KM, Grocott MP Title: Risk stratification tools for predicting morbidity and mortality in adult patients undergoing major surgery: qualitative systematic review Publication: Anesthesiology Journal website PubMed citation