Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachussets, USA.
Curr Opin Crit Care. 2017 Oct;23(5):417-423. doi: 10.1097/MCC.0000000000000445.
Preoperative risk assessment and perioperative factors may help identify patients at increased risk of postoperative complications and allow postoperative management strategies that improve patient outcomes. This review summarizes historical and more recent scoring systems for predicting patients with increased morbidity and mortality in the postoperative period.
Most prediction scores predict postoperative mortality with, at best, moderate accuracy. Scores that incorporate surgery-specific and intraoperative covariates may improve the accuracy of traditional scores. Traditional risk factors including increased ASA physical status score, emergent surgery, intraoperative blood loss and hemodynamic instability are consistently associated with increased mortality using most scoring systems.
Preoperative clinical risk indices and risk calculators estimate surgical risk with moderate accuracy. Surgery-specific risk calculators are helpful in identifying patients at increased risk of 30-day mortality. Particular attention should be paid to intraoperative hemodynamic instability, blood loss, extent of surgical excision and volume of resection.
术前风险评估和围手术期因素有助于识别术后并发症风险增加的患者，并制定改善患者预后的术后管理策略。本文综述了用于预测术后发病率和死亡率增加患者的历史和近期评分系统。
大多数预测评分系统对术后死亡率的预测准确率仅为中等。纳入手术特异性和术中变量的评分可能会提高传统评分的准确性。传统危险因素，包括美国麻醉医师协会（ASA）身体状况评分增加、急症手术、术中失血量和血流动力学不稳定等，在大多数评分系统中均与死亡率增加相关。
术前临床风险指数和风险计算器对手术风险的评估具有中等准确性。特定于手术的风险计算器有助于识别 30 天死亡率增加的患者。术中应特别注意血流动力学不稳定、失血量、手术切除范围和切除体积。
