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Simplified risk stratification in elective colorectal surgery.

Thomas A Bowles1, Kerrie M Sanders, Mark Colson

  • 1Department of Clinical and Biomedical Sciences (Surgery), Barwon Health, University of Melbourne, Geelong, Australia. tom@bowles.id.au

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Summary

Risk stratification using American Society of Anaesthesiologists (ASA) scores, Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), and patient comorbidities accurately predict mortality and morbidity in colorectal surgery. Comorbidities offer a simple and effective method for risk assessment.

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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.