Evaluation of Perioperative Scores Specific to Orthopedic Surgery Related to Intensive Care Admission and Mortality: CCI, ARISCAT and SAPS3 as Valuable Perioperative Orthopedic Risk Scores

Abstract

Introduction: Estimating intensive care admission of orthopedic patients is challenging because of patient variance and multiple comorbidities, primarily in geriatrics, and not yet standardized for the planned and qualified utility of hospital services. This study aimed to reveal the perioperative risk scores of orthopedic patients followed postoperatively in intensive care to investigate the efficacy of these scores in predicting intensive care admission and mortality. Methods: Patients transferred from the orthopedic ward to the intensive care unit (ICU) at any time during their postoperative follow-up from 2022 to 2023 were investigated. Primarily searched scores were the Surgical Apgar, Wells for pulmonary embolism, Charlson Comorbidity Index, ARISCAT for Postoperative Pulmonary Complications preoperatively, and Simplified Acute Physiology III, Sequential Organ Failure Assessment (SOFA), quick-SOFA, and Acute Physiology and Chronic Health Evaluation postoperatively. These scores were evaluated in relation to total intensive care and hospital stay with mortality. Results: The majority of the study population was found to be ASA-2 (45%). Ninety-eight percent of the patients were admitted to the ICU within three postoperative days, with the indication of planned postoperative follow-up mainly after proximal femoral nailing (24%). Among preoperative scores, wells had a significant positive correlation with ICU readmission and length of ICU stay (r=0.32, p=0.001). 62.7% of the patients had severe Charlson Comorbidity Risk Index. Up to postoperative scores, SAPS3 had a significant positive correlation with total ICU and hospital stay, with a significant difference in mortality (p=<0.001). Conclusion: Among preoperative risk scores, the Charlson comorbidity index and ARISCAT scores could be valuable in predicting the need for postoperative intensive care for orthopedic surgery. Evaluating the daily postoperative SAPS3 score of these patients at the orthopedic ward could help organize patient care services and guide early critical care consultation.

Keywords

• surgical apgar score
• simplified acute physiology score 3
• wells score
• charlson comorbidity index
• intensive care
• orthopedic surgery