• Tak Kyu Oh, Young-Tae Jeon, Sang-Hwan Do, and Jung-Won Hwang.
• From the Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam (TKO, Y-TJ, S-HD, J-WH), and Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea (Y-TJ, S-HD, J-WH).
• Eur J Anaesthesiol. 2019 Sep 1; 36 (9): 688-694.

BackgroundThe quick Sequential Organ Failure Assessment (qSOFA) is intended for the assessment of the prognosis and risk of sepsis. It may also help predict the mortality risk of nonseptic patients.ObjectiveThis study investigated the relationship between pre-operative qSOFA scores and 30-day mortality after major surgery. It also evaluated the predictive value of qSOFA scores combined with the American Society of Anesthesiologists (ASA) physical status and Charlson comorbidity index (CCI).DesignA retrospective observational study.SettingSingle tertiary academic hospital.PatientsMedical records of patients who underwent major surgery (estimated blood loss >500 ml; surgery time >2 h) between January 2010 and December 2017 were examined.Main Outcome MeasuresThe qSOFA score was measured within 24 h before surgery, and its association with 30-day mortality was analysed using multivariable logistic regression. A receiver-operating characteristic curve analysis was used to investigate the predictive power of the pre-operative qSOFA scores combined with the ASA physical status and with CCI.ResultsA total of 6336 patients were included in the final analysis, and 91 (1.4%) died within 30 days. The multivariable logistic regression analysis including all covariates indicated that 30-day mortality was 2.43-times higher for the score 1 group than for the score 0 group (P = 0.002), and it was 3.54-times higher for the score at least 2 group than for the score 0 group (P < 0.001). The area under the curve (AUC) of the pre-operative qSOFA, ASA physical status and CCI were 0.69, 0.55 and 0.57, respectively. When the pre-operative qSOFA score was combined with the ASA physical status or CCI, the AUCs were 0.73 and 0.72, respectively.ConclusionHigher pre-operative qSOFA scores within 24 h of surgery were associated with increased 30-day mortality. Pre-operative qSOFA scores have better predictive value for 30-day mortality when combined with the ASA physical status or CCI.

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