Risk Stratification in Emergency Surgical Patients

Hypotheses: The APACHE II (Acute Physiology and Chronic Health Evaluation II) score used as an inten- sive care unit (ICU) admission score in emergency surgical patients is not independent of the effects of treat- ment and might lead to considerable bias in the compa- rability of defined groups of patients and in the evalua- tion of treatment policies. Postoperative monitoring with the APACHE II score is clinically irrelevant. Design: Inception cohort study. Setting: Secondary referral center. Patients: Eighty-five consecutive emergency surgical patients admitted to the surgical ICU in 1999. The APACHE II score was calculated before surgery; after admission to the ICU; and on postoperative days 3, 7, and 10.