The Surgical Risk Scale (SRS): Mortality in general surgical patients.
The SRS is easy to use, formulate and interpret, and provides an accurate prediction of death in general surgical patients across the entire risk spectrum. 

The SRS score consists of a combination of the CEPOD, ASA, and BUPA. Descriptions of these scores: 
  • Confidential Enquiry into Perioperative Deaths (CEPOD)
    • Elective: Routine booked non-urgent case, e.g. varicose veins or hernia.
    • Scheduled: Booked admission, e.g. cancer of the colon or abdominal aortic aneurysm (AAA)
    • Urgent: Cases requiring treatment within 24-48 h of admission, e.g. obstructed colon
    • Emergency: Cases requiring immediate treatment, e.g. ruptured AAA
  • British United Provident Association (BUPA) scores.
    • Minor: Removal of sebaceous cyst, skin lesions, oesophagogastric duodenoscopy.
    • Intermediate: Unilateral varicose veins, unilateral hernia repair, colonoscopy.
    • Major: Appendicectomy, open cholecystectomy. 
    • Major plus: Gastrectomy, any colectomy, laparoscopic cholecystectomy. 
    • Complex major: Carotid endarterectomy, AAA repair, limb salvage, anterior resection, oesophagectomy. 
  • American Society of Anesthesiologists (ASA):
    • I: No systemic disease.
    • II: Mild systemic disease.
    • III: Systemic disease affecting activity.
    • IV: Serious disease but no moribund.
    • V: Moribund, not expected to survive. 
Research authors: R. Sutton, S. Bann, M. Brooks, S. Sarin
Version: 1.8
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The SRS may enhance the ability of the surgeon to form a more objective and accurate preoperative assessment of risk, which could then improve the information given to the patient and relatives. However, the SRS is principally a tool for comparative audit and is not designed to affect the decision to operate, a decision that must always remain clinical. 

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