ANE 600

Pre-operative risk assessment

When a patient is scheduled for elective or emergent surgery, the risk for complications during

surgery is always there. Whether it be from aspiration, bleeding, drug reaction, or

cardiovascular complications. The goal to keep the patient safe before, during, and after

surgery should be the top priority for every anesthesia provider and physician. The article I have

chosen to evaluate discusses the implementation of a new score method which can be used to

help predict post-operative complications. The Anesthesiological and Surgical Postoperative

Risk Assessment (ASPRA) was created to try and reduce morbidity and mortality for high-risk

surgical patients. Many times, when a patient needs emergent or elective surgery, it is left up to

the discretion of the surgeon to decide where a patient goes after the surgery is completed.

This is a subjective assessment made by a single physician and can many times lead to

postoperative complications. With the use of a pre-op evaluation tool, immediate clinical

information is used to help identify high risk patients which may need to be admitted to a unit

that provides a higher level of care. Data from 1928 patients were evaluated in a retrospective

validation process. These cases were evaluated for the type of surgery being performed and for

any post-operative complications that happened during or after the procedure. All cases with

post-operative complications were assigned an ASPRA score. A score of 1 was given to lower

risk patients, a score of 2 for medium risk patients, and a score of 3 for higher risk patients.

Surgical procedure risk factors and comorbidity factors were also calculated for a total overall

ASPRA score. Any patient with an ASPRA score > 7 was considered a high risk surgical patient

who would benefit from being admitted to the ICU or a unit with a higher level of care for
surgical recovery. The study found a positive correlation between the ASPRA score and the

severity of complications using the Spearman’s test. They also found that the assigning of an

ASPRA score to each patient was thought to be simple and fast since it only used clinical data

that was obtainable from the patient’s chart. One limitation that myself and the authors agree

on would be to confirm the results of the study by performing a large prospective study to

validate the usefulness of the tool. It would also be useful to utilize the tool in real time instead

of performing a retrospective study. Overall this tool was shown to be very effective and could

help prevent post-operative complications. It is my opinion that when there is a way to help

reduce the risk of complications for patients and improve their way of life, it should be

implanted and perfected. I would want everything done to keep my family safe when in the

care of the surgical team.

Reference

Chelazzi, C., Villa, G., Vignale, I., Falsini, S., Boni, L., & DE Gaudio, A.R. (2015). Implementation

and preliminary validation of a new score that predicts post-operative complications.

Acta Anaesthesiologica Scandinavica, 59(5), 609-618. doi:10.1111/aas.12488