Triage of high-risk surgical patients for intensive care

Table 1 Select scoring systems available for assessment of postoperative risk

Scoring system	Year	Number of variables	Inclusion of intraoperative variables	Outcomes predicted	Simplicity	Objectivity
Preoperative
ASA	1941	Unlimited	No	None	Simple	Subjective
Charlson Comorbidity Index	1987	19	No	Mortality	Mildly complex	Objective
RCRI	1999	6	No	Major cardiac complication	Simple	Objective
Postoperative
P-POSSUM	1998	12 physiologic,	Yes	Morbidity & mortality	Complex	Objective
		6 operative
E-PASS	2001	6 preoperative,	Yes	Morbidity & mortality	Complex	Subjective (includes
		3 operative				ASA)
NSQIP	1997	57 preoperative,	Yes	Morbidity & mortality	Complex	Subjective (includes
		15 operative				ASA)
SAS	2007	3 operative	Yes	Morbidity & mortality	Simple	Objective
Intensive care
APACHE I-IV*	1981-2006	> 10*	No	Mortality	Complex	Objective
SAPS I-III*	1983-2005	> 10*	No	Mortality	Complex	Objective
MPM I-III*	1985-2007	> 10*	No	Mortality	Complex	Objective
SOFA	1994	6	No	None	Mildly complex	Objective
MODS	1995	6	No	None	Mildly complex	Objective

* Dependent on the version of the scoring system used
ASA: American Society of Anesthesiologists' physical status; RCRI: Revised Cardiac Risk Index; APACHE: Acute Physiology and Chronic Health Evaluation; SAPS: Simplified Acute Physiology Score; MPM: Mortality Probability Model; SOFA: Sequential Organ Failure Assessment; MODS: Multiple Organ Dysfunction Score; P-POSSUM: Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity; E-PASS: Estimation of Physiologic Ability and Surgical Stress; NSQIP: National Surgical Quality Improvement Program; SAS: Surgical Apgar Score.

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