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

被引：70

作者：

Rix T.E. ^{[1
]}

Bates T. ^{[2
]}

机构：

[1] Department of General Surgery, Eastbourne District General Hospital, Eastbourne, East Sussex

[2] Kent Institute of Medicine and Health Sciences, University of Kent, Canterbury, Kent

来源：

World Journal of Emergency Surgery | / 2卷 / 1期

关键词：

Abdominal Aortic Aneurysm; Receiver Operator Characteristic Curve Analysis; Emergency Laparotomy; Fitness Score; Perforated Peptic Ulcer;

D O I：

10.1186/1749-7922-2-16

中图分类号：

学科分类号：

摘要：

Background: The decision on whether to operate on a sick elderly person with an intraabdominal 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.

引用

共 55 条

[1]

New classification of physical status, Anesthesiology, 24, (1963)

[2]

Seymour D.G., Pringle R., A new method of auditing surgical mortality rates: Application to a group of elderly general surgical patients, BMJ, 284, pp. 1539-1542, (1982)

[3]

Goldman L., Caldera D.L., Nussbaum S.R., Southwick F.S., Krogstad D., Murray B., Et al., Multifactorial index of cardiac risk in noncardiac surgical procedures, N Engl J Med, 297, pp. 845-850, (1977)

[4]

Kroenke K., Lawrence V.A., Theroux J.F., Tuley M.R., Hilsenbeck S., Postoperative complications after thoracic and major abdominal surgery in patients with and without obstructive lung disease, Chest, 104, pp. 1445-1451, (1993)

[5]

Mullen J.L., Gertner M.H., Buzby G.P., Goodhart G.L., Rosato E.F., Implications of malnutrition in the surgical patient, Arch Surg, 114, pp. 121-125, (1979)

[6]

Copeland G.P., Jones D., Walters M., POSSUM: A scoring system for surgical audit, Br J Surg, 78, pp. 355-360, (1991)

[7]

Prytherch D.R., Whiteley M.S., Higgins B., Weaver P.C., Prout W.G., Powell S.J., POSSUM and Portsmouth POSSUM for predicting mortality, Br J Surg, 85, pp. 1217-1220, (1998)

[8]

Knaus W.A., Zimmerman J.E., Wagner D.P., Draper E.A., Lawrence D.E., APACHE - acute physiology and chronic health evaluation: A physiologically based classification system, Crit Care Med, 13, pp. 818-829, (1985)

[9]

Goffi L., Saba V., Ghiselli R., Necozione S., Mattel 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, 165, pp. 730-735, (1999)

[10]

Bergner M., Bobbitt R.A., Pollard W.E., Sickness Impact Profile: Validation of a health status measure, Med Care, 14, pp. 57-61, (1976)

← 1 2 3 4 5 6 →