The Waterlow score for risk assessment in surgical patients
Perioperative scoring systems aim to predict outcome following surgery and are used in preoperative counselling to guide management and to facilitate internal or external audit. The Waterlow score is used prospectively in many UK hospitals to stratify the risk of decubitus ulcer development. The pri...
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| Veröffentlicht in: | Annals of the Royal College of Surgeons of England 2013-01, Vol.95 (1), p.52-56 |
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| creator | Thorn, C C Smith, M Aziz, O Holme, T C |
| description | Perioperative scoring systems aim to predict outcome following surgery and are used in preoperative counselling to guide management and to facilitate internal or external audit. The Waterlow score is used prospectively in many UK hospitals to stratify the risk of decubitus ulcer development. The primary aim of this study was to assess the potential value of this existing scoring system in the prediction of mortality and morbidity in a general surgical and vascular cohort.
A total of 101 consecutive moderate to high risk emergency and elective surgical patients were identified through a single institution database. The preoperative Waterlow score and outcome data pertaining to that admission were collected. The discriminatory power of the Waterlow score was compared against that of the American Society of Anesthesiologists (ASA) grade and the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM).
The inpatient mortality rate was 17% and the 30-day morbidity rate was 29%. A statistically significant association was demonstrated between the preoperative Waterlow score and inpatient mortality (p |
| doi_str_mv | 10.1308/003588413X13511609954770 |
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A total of 101 consecutive moderate to high risk emergency and elective surgical patients were identified through a single institution database. The preoperative Waterlow score and outcome data pertaining to that admission were collected. The discriminatory power of the Waterlow score was compared against that of the American Society of Anesthesiologists (ASA) grade and the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM).
The inpatient mortality rate was 17% and the 30-day morbidity rate was 29%. A statistically significant association was demonstrated between the preoperative Waterlow score and inpatient mortality (p<0.0001) and 30-day morbidity (p=0.0002). Using a threshold Waterlow score of 20 to dichotomise risk, accuracies of 0.84 and 0.76 for prediction of mortality and morbidity were demonstrated. In comparison with P-POSSUM, the preoperative Waterlow score performed well on receiver operating characteristic analysis. With respect to mortality, the area under the curve was 0.81 (0.80-0.85) and for morbidity it was 0.72 (0.69-0.76). The ASA grade achieved a similar level of discrimination.
The Waterlow score is collected routinely by nursing staff in many hospitals and might therefore be an attractive means of predicting postoperative morbidity and mortality. It might also function to stratify perioperative risk for comparison of surgical outcome data. A prospective study comparing these risk prediction scores is required to support these findings.</description><identifier>ISSN: 0035-8843</identifier><identifier>EISSN: 1478-7083</identifier><identifier>DOI: 10.1308/003588413X13511609954770</identifier><identifier>PMID: 23317729</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Aged ; Cholecystectomy ; Elective Surgical Procedures - mortality ; Emergency Treatment - mortality ; Female ; Hospital Mortality ; Hospitals ; Humans ; Intensive care ; Length of Stay - statistics & numerical data ; Male ; Middle Aged ; Morbidity ; Mortality ; Patients ; Physiology ; Preoperative Care - mortality ; Pressure ulcers ; Prevention ; Risk assessment ; Risk Assessment - methods ; ROC Curve ; Sensitivity and Specificity ; Severity of Illness Index ; Surgeons ; Surgery ; Surgery in General ; Surgical outcomes ; Vascular Surgical Procedures - mortality</subject><ispartof>Annals of the Royal College of Surgeons of England, 2013-01, Vol.95 (1), p.52-56</ispartof><rights>Copyright Royal College of Surgeons of England Jan 2013</rights><rights>Copyright © 2013 Royal College of Surgeons 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-9f5bd5211f46587e5e1815a9adf2f678b29115aa994ed5a14e6ee9864aebbc943</citedby><cites>FETCH-LOGICAL-c448t-9f5bd5211f46587e5e1815a9adf2f678b29115aa994ed5a14e6ee9864aebbc943</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964640/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964640/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27922,27923,53789,53791</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23317729$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thorn, C C</creatorcontrib><creatorcontrib>Smith, M</creatorcontrib><creatorcontrib>Aziz, O</creatorcontrib><creatorcontrib>Holme, T C</creatorcontrib><title>The Waterlow score for risk assessment in surgical patients</title><title>Annals of the Royal College of Surgeons of England</title><addtitle>Ann R Coll Surg Engl</addtitle><description>Perioperative scoring systems aim to predict outcome following surgery and are used in preoperative counselling to guide management and to facilitate internal or external audit. The Waterlow score is used prospectively in many UK hospitals to stratify the risk of decubitus ulcer development. The primary aim of this study was to assess the potential value of this existing scoring system in the prediction of mortality and morbidity in a general surgical and vascular cohort.
A total of 101 consecutive moderate to high risk emergency and elective surgical patients were identified through a single institution database. The preoperative Waterlow score and outcome data pertaining to that admission were collected. The discriminatory power of the Waterlow score was compared against that of the American Society of Anesthesiologists (ASA) grade and the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM).
The inpatient mortality rate was 17% and the 30-day morbidity rate was 29%. A statistically significant association was demonstrated between the preoperative Waterlow score and inpatient mortality (p<0.0001) and 30-day morbidity (p=0.0002). Using a threshold Waterlow score of 20 to dichotomise risk, accuracies of 0.84 and 0.76 for prediction of mortality and morbidity were demonstrated. In comparison with P-POSSUM, the preoperative Waterlow score performed well on receiver operating characteristic analysis. With respect to mortality, the area under the curve was 0.81 (0.80-0.85) and for morbidity it was 0.72 (0.69-0.76). The ASA grade achieved a similar level of discrimination.
The Waterlow score is collected routinely by nursing staff in many hospitals and might therefore be an attractive means of predicting postoperative morbidity and mortality. It might also function to stratify perioperative risk for comparison of surgical outcome data. A prospective study comparing these risk prediction scores is required to support these findings.</description><subject>Aged</subject><subject>Cholecystectomy</subject><subject>Elective Surgical Procedures - mortality</subject><subject>Emergency Treatment - mortality</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Patients</subject><subject>Physiology</subject><subject>Preoperative Care - mortality</subject><subject>Pressure ulcers</subject><subject>Prevention</subject><subject>Risk assessment</subject><subject>Risk Assessment - methods</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Severity of Illness Index</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgery in General</subject><subject>Surgical outcomes</subject><subject>Vascular Surgical Procedures - mortality</subject><issn>0035-8843</issn><issn>1478-7083</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kctKBTEMhosoery8ghTcuBltepm2CIIcvIHgRtFd6czJ6Oic6bGdUXx7K15QwVVI8uVPwk8IBbYHgpl9xoQyRoK4BaEASmatklqzJTIBqU2hmRHLZPKOFZkTa2Q9pQfGwGoDq2SNCwFaczshB1f3SG_8gLELLzTVISJtQqSxTY_Up4QpzbEfaNvTNMa7tvYdXfihzbW0SVYa3yXc-owb5Prk-Gp6Vlxcnp5Pjy6KWkozFLZR1UxxgEaWymhUCAaUt37W8KbUpuIWcu6tlThTHiSWiNaU0mNV1VaKDXL4obsYqznO6rw7-s4tYjv38dUF37rfnb69d3fh2QlbylKyLLD7KRDD04hpcPM21dh1vscwJgdcCyWNUDyjO3_QhzDGPr_nOGfaKG1KkSnzQdUxpBSx-T4GmHt3yP3nUB7d_vnM9-CXJeINTDGMTw</recordid><startdate>201301</startdate><enddate>201301</enddate><creator>Thorn, C C</creator><creator>Smith, M</creator><creator>Aziz, O</creator><creator>Holme, T C</creator><general>BMJ Publishing Group LTD</general><general>Royal College of Surgeons</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>EHMNL</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201301</creationdate><title>The Waterlow score for risk assessment in surgical patients</title><author>Thorn, C C ; Smith, M ; Aziz, O ; Holme, T C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-9f5bd5211f46587e5e1815a9adf2f678b29115aa994ed5a14e6ee9864aebbc943</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Cholecystectomy</topic><topic>Elective Surgical Procedures - mortality</topic><topic>Emergency Treatment - mortality</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Intensive care</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Patients</topic><topic>Physiology</topic><topic>Preoperative Care - mortality</topic><topic>Pressure ulcers</topic><topic>Prevention</topic><topic>Risk assessment</topic><topic>Risk Assessment - methods</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Severity of Illness Index</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgery in General</topic><topic>Surgical outcomes</topic><topic>Vascular Surgical Procedures - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thorn, C C</creatorcontrib><creatorcontrib>Smith, M</creatorcontrib><creatorcontrib>Aziz, O</creatorcontrib><creatorcontrib>Holme, T C</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>UK & Ireland Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of the Royal College of Surgeons of England</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thorn, C C</au><au>Smith, M</au><au>Aziz, O</au><au>Holme, T C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Waterlow score for risk assessment in surgical patients</atitle><jtitle>Annals of the Royal College of Surgeons of England</jtitle><addtitle>Ann R Coll Surg Engl</addtitle><date>2013-01</date><risdate>2013</risdate><volume>95</volume><issue>1</issue><spage>52</spage><epage>56</epage><pages>52-56</pages><issn>0035-8843</issn><eissn>1478-7083</eissn><abstract>Perioperative scoring systems aim to predict outcome following surgery and are used in preoperative counselling to guide management and to facilitate internal or external audit. The Waterlow score is used prospectively in many UK hospitals to stratify the risk of decubitus ulcer development. The primary aim of this study was to assess the potential value of this existing scoring system in the prediction of mortality and morbidity in a general surgical and vascular cohort.
A total of 101 consecutive moderate to high risk emergency and elective surgical patients were identified through a single institution database. The preoperative Waterlow score and outcome data pertaining to that admission were collected. The discriminatory power of the Waterlow score was compared against that of the American Society of Anesthesiologists (ASA) grade and the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM).
The inpatient mortality rate was 17% and the 30-day morbidity rate was 29%. A statistically significant association was demonstrated between the preoperative Waterlow score and inpatient mortality (p<0.0001) and 30-day morbidity (p=0.0002). Using a threshold Waterlow score of 20 to dichotomise risk, accuracies of 0.84 and 0.76 for prediction of mortality and morbidity were demonstrated. In comparison with P-POSSUM, the preoperative Waterlow score performed well on receiver operating characteristic analysis. With respect to mortality, the area under the curve was 0.81 (0.80-0.85) and for morbidity it was 0.72 (0.69-0.76). The ASA grade achieved a similar level of discrimination.
The Waterlow score is collected routinely by nursing staff in many hospitals and might therefore be an attractive means of predicting postoperative morbidity and mortality. It might also function to stratify perioperative risk for comparison of surgical outcome data. A prospective study comparing these risk prediction scores is required to support these findings.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>23317729</pmid><doi>10.1308/003588413X13511609954770</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Cholecystectomy Elective Surgical Procedures - mortality Emergency Treatment - mortality Female Hospital Mortality Hospitals Humans Intensive care Length of Stay - statistics & numerical data Male Middle Aged Morbidity Mortality Patients Physiology Preoperative Care - mortality Pressure ulcers Prevention Risk assessment Risk Assessment - methods ROC Curve Sensitivity and Specificity Severity of Illness Index Surgeons Surgery Surgery in General Surgical outcomes Vascular Surgical Procedures - mortality |
| title | The Waterlow score for risk assessment in surgical patients |
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