Geriatric rescue after surgery (GRAS) score to predict failure-to-rescue in geriatric emergency general surgery patients

Am J Surg. 2018 Jan;215(1):53-57. doi: 10.1016/j.amjsurg.2017.08.002. Epub 2017 Aug 15.

Abstract

Background: Geriatric-patients(GP) undergoing emergency-general-surgery(EGS) are vulnerable to develop adverse-outcomes. Impact of patient-level-factors on Failure-to-Rescue(FTR) in EGS-GP remains unclear. Aim of our study was to determine factors associated with FTR(death from major-complication) and devise simple-bedside-score that predicts FTR in EGS-GP.

Methods: 3-year(2013-15) analysis of patients, age≥65y on acute-care-surgery-service and underwent EGS. Regression analysis used to analyze factors associated with FTR and natural-logarithm of significant odds-ratio used to calculate estimated-weights for each factor. Geriatric-Rescue-After-Surgery(GRAS)-score calculated for each-patient. AUROC used to assess model discrimination.

Results: 725 EGS-patients analyzed. 44.6%(n = 324) had major-complications. The FTR-rate was 11.5%. Overall-mortality rate was 15.3%. On regression, significant-factors with their estimated-weights were:Age≥80y(2), Chronic-Obstructive-Pulmonary-Disease(COPD)(1), Chronic-renal-failure(CRF)(2), Congestive-heart-failure(CHF)(1), Albumin<3.5(1) and ASA score>3(2). AUROC of score was 0.787.

Conclusion: GRAS-score is first score based on preoperative assessment that can reliably predict FTR in EGS-GP. Preoperative identification of patients at increased-risk of FTR can help in risk-stratification and timely-mobilization of resources for successful rescue of these patients.

Keywords: Emergency general surgery; Failure to rescue; Geriatric surgery.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Decision Support Techniques*
  • Emergencies
  • Failure to Rescue, Health Care*
  • Female
  • General Surgery
  • Health Status Indicators*
  • Humans
  • Logistic Models
  • Male
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality*
  • Postoperative Complications / therapy
  • Retrospective Studies
  • Risk Factors