Simplified risk stratification in elective colorectal surgery

Area of Science:

• Colorectal Surgery
• Surgical Outcomes Research
• Patient Risk Stratification

Background:

• Surgical audit outcomes require accurate risk stratification to account for patient case mix.
• Existing tools like ASA and POSSUM predict outcomes but necessitate extensive data collection.
• Previous findings on comorbidities as mortality predictors require confirmation.

Purpose of the Study:

• To compare the predictive accuracy of established risk stratification tools (ASA, POSSUM) with patient comorbidities for surgical outcomes.
• To validate whether the presence of comorbidities accurately predicts morbidity and mortality in colorectal surgery.

Main Methods:

• Utilized data from an existing colorectal audit including ASA, POSSUM, comorbidities, and surgical outcomes.
• Incorporated preoperative cardiopulmonary exercise test data from the anaesthetic department.
• Defined poor surgical outcome as mortality, anastomotic leak, or complications requiring significant intervention.

Main Results:

• American Society of Anaesthesiologists (ASA) scores, Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) scores >30, and the presence of two comorbidities predicted mortality and severe complications.
• Anaerobic threshold <11 mL/min/kg did not predict poor surgical outcome.
• Anastomotic leak was not predicted by any of the assessed scoring systems.

Conclusions:

• ASA, POSSUM, and having two or more comorbidities are significant predictors of mortality and morbidity, excluding anastomotic leaks.
• Patient comorbidities provide a simple, quick, and effective method for risk stratification in colorectal surgery, comparable to POSSUM.
• Comorbidities represent a valuable tool for assessing surgical risk due to ease of collection and strong outcome correlation.