Preoperative APACHE II and ASA scores in patients having major general surgical operations: prognostic value and potential clinical applications

OBJECTIVE: To assess the prognostic value of the APACHE II score and the American Society of Anesthesiologists (ASA) classification system in preoperative evaluation of patients. DESIGN: Prospective study. SETTING: University hospital, Italy. SUBJECTS: 187 consecutive patients undergoing elective or emergency major general surgical operations. INTERVENTIONS: Patients were evaluated preoperatively using both indices. MAIN OUTCOME MEASURES: Morbidity and mortality within 30 days. RESULTS: Logistic regression and ROC curve analyses showed that the APACHE II score predicted morbidity and mortality well; it was superior to the ASA system in predicting outcome (area under the curve 0.894 for the APACHE II index, 0.777 for the ASA system; p < 0.001). The APACHE II score without its age points (area 0.888) had the same prognostic value as the complete score (area 0.894; p = 0.55). CONCLUSIONS: The APACHE II score may help clinicians to evaluate preoperatively the risk of postoperative morbidity and death after major general surgical operations. Age does not seem to have a specific weight.