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 accurately predicted mortality in higher-risk surgical patients. The accuracy of prediction equalled that of POSSUM and p-POSSUM.

Stripping of the long saphenous vein (LSV) may prevent recurrence of varices, although this has not been demonstrated using objective criteria. The aim of this study was to determine whether the addition of LSV stripping, from groin to upper calf, to saphenofemoral junction (SFJ) ligation prevents residual reflux, and whether LSV stripping to the upper calf results in greater neurological complications. Sixty-nine patients with primary varicose veins, LSV reflux and SFJ incompetence, confirmed by duplex ultrasonography and photoplethysmography, were studied. A total of 105 limbs were treated by SFJ ligation and avulsion of varices; patients were randomized to undergo stripping of the LSV to the upper calf (n = 49) or no additional treatment (n = 56). Three months after surgery all patients were examined clinically, by duplex ultrasonography and by photoplethysmographic tests of venous function, to establish the extent of persisting varices. Fewer persisting incompetent LSVs in the calf were found when the LSV was stripped (n = 9) than after SFJ ligation alone (n = 25) (P < 0.01). Photoplethysmographic refilling times were improved to a similar extent in both groups after surgery but were lower in those who had residual LSV reflux (P < 0.05). Six limbs developed paraesthesia in the distribution of the saphenous nerve: two in the group that were stripped and four in those that were not. These data suggest that LSV reflux is more completely abolished by combining LSV stripping with SFJ ligation; stripping the LSV to the upper calf does not result in a higher incidence of injury to the saphenous nerve.

Eighty-nine legs with long saphenous vein (LSV) reflux and saphenofemoral junction incompetence were treated by saphenofemoral ligation and multiple avulsions; patients were randomized to undergo additional stripping of the LSV from groin to upper calf (n = 43) or no additional treatment (n = 46). At a median of 21 months after surgery recurrence was evaluated by duplex ultrasonography, photoplethysmography, clinical examination and patient assessment. Fewer persisting incompetent LSVs in the calf were found (21 versus 38) and median (interquartile range) photoplethysmographic refilling times were longer (20 (13-27) versus 14 (11-21) s) when the LSV was stripped than after saphenofemoral ligation alone (both P < 0.1). More patients were completely satisfied (65 versus 37 percent and were recurrence-free (65 versus 17 per cent) when the LSV had been stripped compared with saphenofemoral ligation alone (P < 0.05 and P < 0.001 respectively). The addition of LSV stripping to saphenofemoral ligation and multiple avulsions results in a better overall outcome.