Valore prognostico dell'indice Apache II nell'impiego routinario preoperatorio in chirurgia generale maggiore

The authors examined the prognostic value, in daily preoperative practice, of Apache II scoring system in 187 patients undergoing elective or emergency major general surgery, and compared it with those of more traditional classification systems, such as the American Society of Anesthesiologists (ASA) classification system and the Weighted Scale of Operartive Risk (WSOR). Logistic regression analysis and ROC (Receiver Operating Characteristic) curve analysis confirmed Apache II system to have good predictive value for mortality and morbidity; it was superior to the examined traditional classification systems in prediction of outcome after surgery (area under curve 0.89 for the Apache II index, 0.78 for the ASA classification system 0.79 for the WSOR). The Apache II score deprived of the age points (area under curve 0.98) showed the same prognostic power of the complete score (area under curve 0.89), so age alone was not a significant variable in our experience. If used in daily practice the preoperative Apache II score may be used by clinicians to evaluate before surgery the risk of postoperative morbidity and death in major general surgery.