Shock index: Easy to use, but can it predict outcomes following major abdominal emergency surgery?

Major abdominal emergency surgery (MAES) is commonly performed for various potentially life-threatening intra-abdominal surgical conditions with high perioperative mortality of up to 45%.1 Certain patient factors (e.g. advanced age, frailty, and presence of multiple comorbidities) and disease factors (e.g. perforated viscus and intra-abdominal sepsis) have been shown to predict higher post-operative complications and mortality following MAES.2 Pre-operative risk stratification scores, such as the Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) and National Emergency Laparotomy Audit (NELA) score, have also been developed to assist clinicians and/or surgeons in decision making and patient counselling. While these scoring systems have been widely studied and validated in patients of various demographics,3 they require input of multiple variables which may be cumbersome, especially in the emergency setting. Simple bedside scoring systems remain attractive for quick risk stratification and guidance of subsequent management.