The Surgical Risk Scale (SRS) can be used to describe the the level of risk associated with a surgical procedure. It can be used adjust for risk when conducting a surgical audit. The authors are from Watford General Hospital in England.
Parameters:
(1) American Society of Anesthesiology (ASA) class for patient status
(2) Confidential Enquiry into Periooperative Deaths (CEPOD) grade for case scheduling
(3) British United Provident Association (BUPA) grade for operative complexity
|
Parameter |
Finding |
Points |
|
ASA class |
ASA 1 |
1 |
|
|
ASA 2 |
2 |
|
|
ASA 3 |
3 |
|
|
ASA 4 |
4 |
|
|
ASA 5 |
5 |
|
CEPOD scheduling |
routine, non-urgent |
1 |
|
|
scheduled procedure |
2 |
|
|
urgent procedure |
3 |
|
|
emergency procedure |
4 |
|
BUPA |
minor |
1 |
|
|
intermediate |
2 |
|
|
major (open cholecystectomy) |
3 |
|
|
major plus |
4 |
|
|
major complex |
5 |
SRS =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 3
• maximum score: 14
• The higher the SRS the worse the prognosis.
|
SRS |
Operative Mortality |
|
3 to 5 |
0 |
|
6 |
< 1% |
|
7 |
2% |
|
8 |
4% |
|
9 |
10% |
|
10 |
19% |
|
11 |
38% |
|
12 |
58% |
|
13 |
76% |
|
14 |
88% |
Limitations:
• Using a nonlinear ranking may be more accurate (for example, convert each grade to a value on a Borg-type scale). A patient with ASA class 5 is moribund and expected not to survive, which would skew any simple linear score.
• Some combinations would not occur. For example, it is unlikely that a patient with a CEPOD grade 4 would undergo a BUPA grade 1 or 2 procedure.
• There may need to be a level of operative complexity above major complex, taking into account very long operative times.
Specialty: Anesthesiology
ICD-10: ,
