Perioperative risk stratification

Question 1

What is the Euroscore and Parsonnet score?

Answer 1

Scores for predicting operative mortality in cardiac surgical patients

Question 2

What is the Apache II score?

Answer 2

ICU mortality prediction score

Question 3

What is the POSSUM score?

Answer 3

Operative morbidity and mortality risk for general surgery

Variants for vascular and colorectal surgery

Question 4

How is fitness prior to surgery assessed?

Answer 4

ASA physical status classification

Question 5

Define and give examples of ASA I classification

Answer 5

Normal healthy patient

e.g. Healthy, non-smoking, no or minimal alcohol use

Question 6

Define and give examples of ASA II classification

Answer 6

A patient with mild systemic disease

e.g. Without substantive functional limitation. Current smoker, social alcohol drinker, pregnancy, obesity, well-controlled DM/HTN, mild lung disease

Question 7

Define and give examples of ASA III classification

Answer 7

A patient with severe systemic disease

e.g. Substantive functional limitation. 1+ moderate-severe disease. Poorly controlled DM/HTN, COPD, morbid obesity, active hepatitis, alcohol dependence, pacemaker, moderate reduction in ejection fraction, ESRD with regular dialysis, >3 month Hx of MI/CVA/TIA

Question 8

Define and give examples of ASA IV classification

Answer 8

A patient with severe systemic disease that is a constant threat to life

e.g. Recent MI/CVA/TIA/CAD, ongoing cardiac ischaemia or severe valve dysfunction, severe reduction in ejection fraction, sepsis, DIC, ARD or ESRD without dialysis

Question 9

Define and give examples of ASA V classification

Answer 9

A moribund patient who is not expected to survive without the operation

e.g. Ruptured AAA, massive trauma, intracranial bleed with mass effect, ischaemic bowel with significant cardiac pathology or multiple organ dysfunction

Question 10

Define ASA IV classification

Answer 10

A declared brain-dead patient whose organs are being removed for donor purposes