W e use ASA and Modified Lee Cardiac index as routine

Hi Richard. Excluding patients undergoing cardiac surgery, I find the the ACS Surgical Risk Calculator very helpful (see link below). It estimates the chance of an unfavorable outcome (such as a complication or death) after surgery. I often would use this as part of my pre anaesthesia consult with patients (and their families) to openly talk about the risks. One of its advantages is that you can also save the file and even print it for the patient to read through and discuss with their family, GP or other health providers looking after them. 

Please note that the estimates are calculated using data from a large number of patients who had a surgical procedure similar to the one the patient may have and that the risk percentages provided to you by the Surgical Risk Calculator are only estimates. Have a play with it and please let me know what you think of its utility in your practice. 

http://riskcalculator.facs.org

Cheers, Laurence Weinberg

Hello,

in the field of cardiac surgery we use the euroscoreII. This score is a composite one. It is based on the state of the patient before surgery, on the comorbidities and take care about kind of surgical procedure. It is easy to use and give us a risk about surgical procedure. It is broadly used in my hospital.

Hey Richard, 

Good question!  Sometimes it is difficult to predict peri-operative risk. Patients with high level on comorbidity are underestimated when used in prediction systems.   

On our pre-operative outpatient department we  follow the ESC/ESA guidelines about evaluation in non-cardiac surgery. Unfortunately, the guideline manages the risk (only) on MACE. But the system is excellent : 

- type of surgery

- level physical fitness (MET)

- RCRI

Furthermore, the age of the patient and pre-operative level of troponine (hsTNT) are also interesting items.

Together with our vascular surgeons we started a special pre-operative evaluation line for vascular patients. There, I have one hour to evaluate the patient (including lab, ecg, echocardiography). We use ASA/RCRI/VSG and ACS-risk prediction system for these patients. Nearly all patients appreciate using the ACS tool (as a kind of extern expertise).  In cases of very high peri-operative risk the patient has an appointment together with surgeon and anesthesiologist where we advise what to do or not. It is teamwork!

I agree with Laurence from Melbourne  (above), the ACS- NSQIP (via website) is up to now the best system we have. 

ACS-risk calculator

American College of Surgeons National Surgical Quality Improvement Program

- very good database nearly  1.4 mill ingrepen and 400 hospitals

- http://riskcalculator.facs.org 

There are other systems: 

POSSUM model (via website)

- http://www.riskprediction.org.uk

GUPTA-score  is based on 400000 patients

-  http://www.qxmd.com/calculate-online/cardiology/gupta-perioperative-cardiac-risk

   QXMEDICAL (available as App ! ) 

VSG (Vascular Surgery Group New England) 

 - good tool, based on ca. 10000 vascular patients

  http://www.qxmd.com/specialty/vascular-surgery

  http://www.qxmd.com/calculate-online/vascular-surgery/vsg-cardiac-risk-index-endovascular-infrarenal-aaa-repair

  http://www.qxmd.com/calculate-online/vascular-surgery/vsg-cardiac-risk-index-open-infrarenal-aaa-repair 

ASA-score

- is weak  when used as a predictor for morbidity/mortality because it does not reflex the type of surgery. 

Greetings from Rotterdam

Frank

Thank you all for your contributions. I wonder how formal risk assessment methods compare to expert opinion of the anaesthetist/surgeon.