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Kusen JQ, Beeres FJP, van der Vet PCR, Poblete B, Geuss S, Babst R, Knobe M, Wijdicks FJG, Link BC. Inter-rater agreement in pPOSSUM scores of geriatric trauma patients: a prospective evaluation. Arch Orthop Trauma Surg 2022; 142:3869-3876. [PMID: 35031826 DOI: 10.1007/s00402-021-04275-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Risk prediction models are widely used in the perioperative setting to identify high-risk patients who may benefit from additional care and to aid clinical decision-making. pPOSSUM is such a prediction model, however, little is known about the inter-rater agreement when scoring subjective parameters. This study assessed the inter-rater agreement between clinicians of different specialties and work-level when scoring 30 clinical case reports of geriatric hip fracture patients with pPOSSUM. METHODS Eighteen clinicians of the department of Surgery (three specialists, four residents), Anaesthesiology (four specialists, two residents) and Emergency Medicine (three specialists, two residents) who were familiar with the pPOSSUM scoring system were asked to calculate the scores. The kappa statistic and the statistical method of Fleiss were used to analyse inter-rater agreement. RESULTS The response rate was 100%. Among surgeons, Anaesthesiologists and Emergency department doctors (ED), the overall mean kappa values were 0.42, 0.08 and 0.20, respectively. Among surgery, anaesthesiology and ED residents the overall mean kappa values were 0.21, 0.33 and 0.37, respectively. Within the department of Surgery, Anaesthesiology and Emergency Medicine the overall mean kappa values were 0.23, 0.12 and 0.22, respectively. An overall mean kappa value of 0.19 was seen among all specialists. All residents had an overall mean kappa value of 0.21 and all clinicians had an overall mean kappa value of 0.21. CONCLUSION The overall inter-rater agreement of clinicians and interdisciplinary agreement when scoring geriatric hip fracture patients with pPOSSUM was low and prone to subjectivity in our study. A higher work-experience level did not lead to better agreement. When pPOSSUM is calculated without clinical assessment by the same clinician, caution is advised to prevent over-reliance on the pPOSSUM risk prediction model. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jip Q Kusen
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland.
- Department of Orthopaedic and Trauma Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland
| | - Puck C R van der Vet
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland
- Department of Orthopaedic and Trauma Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Beate Poblete
- Department of Anaesthesiology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Steffen Geuss
- Department of Emergency Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland
- Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland
| | - Franciscus J G Wijdicks
- Department of Orthopaedic and Trauma Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Björn C Link
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland.
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Casanova D, Papalois V. SEVE project (Surgical Expertise Validity Evaluation) risk adjusted quality by standard data. Cir Esp 2022; 100:62-66. [PMID: 35148863 DOI: 10.1016/j.cireng.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 06/14/2023]
Abstract
The SEVE project (Surgical Expertise Validity Evaluation) is a collaborative effort of the AEC (Spanish Association of Surgeons) and the Section of Surgery of the European Union of Medical Specialists (UEMS) that aims to develop a model and an on line application that can be used to evaluate surgical complications. The aim is to identify the optimal results that can be obtained in each intervention, in order to present them as a reference for our usual practice (benchmarking).
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Forgione A, Guraya SY, Diana M, Marescaux J. Intraoperative and postoperative complications in colorectal procedures: the role of continuous updating in medicine. Minerva Surg 2021; 76:350-371. [PMID: 33944515 DOI: 10.23736/s2724-5691.21.08638-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Accepting surgical complications, especially those related to the learning curve, as unavoidable events in colorectal procedures, is like accepting to fly onboard an aircraft with a 10 to 20% chance of not arriving at final destination. Under this condition, it is very likely that the aviation industry and the concurrent reshaping of the world and of our lives would have not been possible in the absence of high reliability and reproducibility of safe flights. It's hard to imagine surgery without any intraoperative and/or postoperative complications. Nevertheless, there is a plenty of room for improvement by simply adopting what has been explicitly and scientifically demonstrated; training outside of the OR, usage of modern information technologies and application of evidence-based perioperative care protocols. Additionally, the possibility to objectively measure and monitor the technical and even non-technical skills and competencies of individual surgeons and even of OR teams through the application of structured and validated assessment tools can finally put an end to the self-referential, purely hierarchical, and indeed extremely unreliable process of being authorized or not to perform operations on patients. Last but not least, a wide range of new technologies spanning from augmented imaging modalities, virtual reality for intraoperative guidance, improved robotic manipulators, artificial intelligence to assist in preoperative patient specific risk assessment, and intraoperative decision-making has the potential to tackle several hidden roots of surgical complications.
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Affiliation(s)
- Antonello Forgione
- Advanced International Mininvasive Surgery (AIMS) Academy, Milan, Italy -
| | - Salman Y Guraya
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Michele Diana
- IRCAD, Research Institute against Digestive Cancer, Strasbourg, France.,Photonics for Health, ICube Lab, University of Strasbourg, Strasbourg, France.,Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg 1, Strasbourg, France
| | - Jacques Marescaux
- IRCAD, Research Institute against Digestive Cancer, Strasbourg, France
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Casanova D, Papalois V. SEVE project (Surgical Expertise Validity Evaluation) risk adjusted quality by standard data. Cir Esp 2021; 100:S0009-739X(21)00129-9. [PMID: 35148863 DOI: 10.1016/j.ciresp.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 11/17/2022]
Abstract
The SEVE project (Surgical Expertise Validity Evaluation) is a collaborative effort of the AEC (Spanish Association of Surgeons) and the Section of Surgery of the European Union of Medical Specialists (UEMS) that aims to develop a model and an on line application that can be used to evaluate surgical complications. The aim is to identify the optimal results that can be obtained in each intervention, in order to present them as a reference for our usual practice (benchmarking).
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Evaluation of Predictive Value of P-POSSUM Score in Patients Operated for Acute Abdomen and Comparison of Scoring at Admission and Pre-operatively. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02233-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Karan N, Siddiqui S, Sharma KS, Pantvaidya GH, Divatia JV, Kulkarni AP. Evaluation and validation of Physiological and Operative Severity Score for the enumeration of mortality and morbidity and Portsmouth-POSSUM scores in predicting morbidity and mortality in patients undergoing head and neck cancer surgeries. Head Neck 2020; 42:2968-2974. [PMID: 32715529 DOI: 10.1002/hed.26354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/28/2020] [Accepted: 06/09/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Identification of risk factors for perioperative complications helps in the prognostication. We wanted to determine whether Physiological and Operative Severity Score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) can be used in patients undergoing head and neck oncosurgery. METHODS We conducted a retrospective analysis of 1265 patients after they had major head and neck oncosurgeries. Demographic, surgical and outcome data was collected. We separately analyzed data for patients who had undergone cancer surgery for oral cavity, pharynx, and larynx. We calculated the POSSUM and P-POSSUM scores. RESULTS POSSUM scoring system had moderate discrimination (AUC = 0.61) and good calibration (P = .36) for the entire study cohort and in the subgroup. Since there were no deaths in the entire cohort, we were not able to check predictive ability of the scores, for mortality. CONCLUSIONS We found that POSSUM had moderate discrimination and good calibration for morbidity prediction in head and neck cancer surgeries, as well as for the selected subgroup.
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Affiliation(s)
- Nupur Karan
- Department of Neuroanaesthesia and Critical Care, NIMHANS, Bangalore, India
| | - Suhail Siddiqui
- Department of Critical Care Medicine, King George's Medical University Faculty of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kailash S Sharma
- Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Gouri H Pantvaidya
- Head & Neck Surgical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Jigeeshu V Divatia
- Department of Anaesthesia, Critical Care & Pain, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care & Pain, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
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Jagielski M, Piątkowski J, Jackowski M. Challenges Encountered during the Treatment of Acute Mesenteric Ischemia. Gastroenterol Res Pract 2020; 2020:5316849. [PMID: 32328096 PMCID: PMC7150694 DOI: 10.1155/2020/5316849] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/17/2020] [Indexed: 01/16/2023] Open
Abstract
RESULTS Acute ischemia of the bowel mesentery was diagnosed in 41 patients (27 women and 14 men; mean age, 65.4 years). All patients underwent laparotomy. For 13 (31.71%) patients, surgery was performed within the first 24 hours of the clinical symptom onset. Mesenteric artery embolectomy without intestine resection was performed for 7 (17.07%) patients. Partial intestine resection due to necrosis was performed for 21 (51.22%) patients. Exploratory laparotomy without a therapeutic procedure was performed for 13 (31.71%) patients. Fifteen (36.59%) patients were discharged home in good general condition. Twenty-six (63.41%) patients died. The time from the clinical symptom onset until intervention exceeded 24 hours for all patients who died. Surgery within the first 24 hours reduced mortality associated with acute mesenteric ischemia (P = 0.001). Female sex, age older than 65 years, obesity (body mass index > 30), diabetes, chronic kidney disease, and smoking were adverse prognostic factors for increased mortality for patients with acute bowel ischemia. CONCLUSION The time from clinical symptoms to acute mesenteric ischemia treatment was the main prognostic factor and helped determine appropriate management. Early diagnosis and rapid intervention improved treatment outcomes and survival.
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Affiliation(s)
- Mateusz Jagielski
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum Nicolaus Copernicus University, Toruń, Poland
| | - Jacek Piątkowski
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum Nicolaus Copernicus University, Toruń, Poland
| | - Marek Jackowski
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum Nicolaus Copernicus University, Toruń, Poland
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Echara ML, Singh A, Sharma G. Risk-Adjusted Analysis of Patients Undergoing Emergency Laparotomy Using POSSUM and P-POSSUM Score: A Prospective Study. Niger J Surg 2019; 25:45-51. [PMID: 31007512 PMCID: PMC6452761 DOI: 10.4103/njs.njs_11_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Comparison of operative morbidity rates after emergency laparotomy between units may be misleading because it does not take into account the physiological variables of patients’ conditions. Surgical risk scores have been created, and the most commonly used is the Physiological and Operative Severity Score for the enumeration of Mortality (POSSUM) or one of its modifications, the Portsmouth-POSSUM (P-POSSUM), usually requires intraoperative information. Objective: The objective of this study is to evaluate the POSSUM and P-POSSUM scores in predicting postoperative morbidity and mortality in patients undergoing emergency laparotomy. Methodology: This is a prospective, cross-sectional, and hospital-based study that was conducted at J.L.N. Medical College and Hospital, Ajmer, Rajasthan, India, from April 2017 to December 2017. Adult patients who presented at the causality and underwent emergency laparotomy were included in the study. Observed and predicted mortality and morbidity were calculated using POSSUM and P-POSSUM equations, and statistical significance was calculated using Chi-square test. Results: A total of 100 patients were included in this study, with a mean age of 42.83 ± 18.21 years. The observed (O) mortality was 12 (12.0%), while POSSUM predicted 40 (40%) and P-POSSUM 27 (27%). The O/E ratio for POSSUM was 0.29 and for P-POSSUM was 0.44, and this means that they both overestimate mortality. When the results were tested by Chi-square test, the P value was found to be 0.55 and 0.85 for POSSUM and P-POSSUM, respectively, which showed no significant correlation for observed and expected mortality. The observed morbidity was 69 (69%), while POSSUM expected morbidity was 79 (79%), O/E ratio is 0.87, and this again overestimates the morbidity. POSSUM is overpredicting the rate of morbidity, and test of correlation showed no significance with P = 0.75. Conclusion: POSSUM and P-POSSUM were found to overestimate mortality and morbidity in our patient's population.
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Affiliation(s)
- Mohan Lal Echara
- Department of General Surgery, J.L.N Medical College, Ajmer, Rajasthan, India
| | - Amit Singh
- Department of General Surgery, J.L.N Medical College, Ajmer, Rajasthan, India
| | - Gunjan Sharma
- Department of General Surgery, J.L.N Medical College, Ajmer, Rajasthan, India
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Eamer G, Al-Amoodi MJH, Holroyd-Leduc J, Rolfson DB, Warkentin LM, Khadaroo RG. Review of risk assessment tools to predict morbidity and mortality in elderly surgical patients. Am J Surg 2018; 216:585-594. [PMID: 29776643 DOI: 10.1016/j.amjsurg.2018.04.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/23/2018] [Accepted: 04/11/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Informed surgical consent requires accurate estimation of risks and benefits. Multiple risk assessment tools are available; however, most are not widely used or are specific to certain interventions. Assessing surgical risk is especially challenging in elderly patients because of their range of comorbidities, level of frailty, or severity of illness and a number of available surgical interventions. DATA SOURCES We searched MEDLINE from January 2014 to July 2017 for studies that used risk assessment tools in studies on elderly surgical patients. We then sought the original articles describing each assessment tool and subsequent validation studies. CONCLUSIONS We identified risk assessment tools that can improve surgical risk assessment in elderly surgical patients. The majority of the identified tools are not commonly used for pre-operative risk assessment. NSQIP-PMP, mFI and SURPAS are promising tools. Age is commonly used to predict risk, but frailty may be a more appropriate measure.
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Affiliation(s)
- Gilgamesh Eamer
- Department of Surgery, University of Alberta, Edmonton, Canada
| | | | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary, Calgary, Canada; Department of Medicine, University of Calgary, Calgary, Canada
| | | | | | - Rachel G Khadaroo
- Department of Surgery, University of Alberta, Edmonton, Canada; Department of Critical Care Medicine, University of Alberta, Edmonton, Canada.
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10
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The evaluation of risk prediction models in predicting outcomes after bariatric surgery: a prospective observational cohort pilot study. Perioper Med (Lond) 2018; 7:6. [PMID: 29651334 PMCID: PMC5894216 DOI: 10.1186/s13741-018-0088-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/02/2018] [Indexed: 02/07/2023] Open
Abstract
Background As the prevalence of obesity is increasing, the number of patients requiring surgical intervention for obesity-related illness is also rising. The aim of this pilot study was to explore predictors of short-term morbidity and longer-term poor weight loss after bariatric surgery. Methods This was a single-centre prospective observational cohort pilot study in patients undergoing bariatric surgery. We assessed the accuracy (discrimination and calibration) of two previously validated risk prediction models (the Physiological and Operative Severity Score for the enumeration of Morbidity and Mortality, POSSUM score, and the Obesity Surgical Mortality Risk Score, OS-MS) for postoperative outcome (postoperative morbidity defined using the Post Operative Morbidity Survey). We then tested the relationship between postoperative morbidity and longer-term weight loss outcome adjusting for known patient risk factors. Results Complete data were collected on 197 patients who underwent surgery for obesity or obesity-related illnesses between March 2010 and September 2013. Results showed POSSUM and OS-MRS were less accurate at predicting Post Operative Morbidity Survey (POMS)-defined morbidity on day 3 than defining prolonged length of stay due to poor mobility and/or POMS-defined morbidity. Having fewer than 28 days alive and out of hospital within 30 days of surgery was predictive of poor weight loss at 1 year, independent of POSSUM-defined risk (odds ratio 2.6; 95% confidence interval 1.28-5.24). Conclusions POSSUM may be used to predict patients who will have prolonged postoperative LOS after bariatric surgery due to morbidity or poor mobility. However, independent of POSSUM score, having less than 28 days alive and out of hospital predicted poor weight loss outcome at 1 year. This adds to the literature that postoperative complications are independently associated with poor longer-term surgical outcomes.
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Segelman J, Mattsson I, Jung B, Nilsson PJ, Palmer G, Buchli C. Risk factors for anastomotic leakage following ileosigmoid or ileorectal anastomosis. Colorectal Dis 2018; 20:304-311. [PMID: 29059489 DOI: 10.1111/codi.13938] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/18/2017] [Indexed: 02/06/2023]
Abstract
AIM Reconstruction with an ileosigmoidal anastomosis (ISA) or ileorectal anastomosis (IRA) is a surgical option after a subtotal colectomy. Anastomotic leakage (AL) is a problematic complication and high rates have been reported, but there is limited understanding of the risk factors involved. The aim of this study was to assess the established and potential predictors of AL following ISA and IRA. METHOD This was a retrospective cohort study including all patients who had undergone ISA or IRA at three Swedish referral centres for colorectal surgery between January 2007 and March 2015. Data regarding clinical characteristics, treatment and outcome were collected from medical records. Univariate and multivariate logistic regression models were used to determine the association between patient and treatment related factors and the cumulative incidence of AL. RESULTS In total, 227 patients were included. Overall, AL was detected amongst 30 patients (13.2%). Amongst patients undergoing colectomy with synchronous ISA or IRA (one-stage procedure), AL occurred in 23 out of 120 (19.2%) compared with seven out of 107 (6.5%) after stoma reversal with ISA or IRA (two-stage procedure) (P = 0.004). In addition, the multivariate analyses revealed a statistically significantly lower odds ratio for AL following a two-stage procedure (OR 0.10, 95% CI 0.03-0.41, P = 0.001). CONCLUSIONS This study confirms high rates of AL following ISA and IRA. In particular, a synchronous procedure with colectomy and ISA/IRA carries a high risk of AL.
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Affiliation(s)
- J Segelman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - I Mattsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - B Jung
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - P J Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - G Palmer
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - C Buchli
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
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Carvalho-E-Carvalho ME, DE-Queiroz FL, Martins-DA-Costa BX, Werneck-Côrtes MG, Pires-Rodrigues V. The applicability of POSSUM and P-POSSUM scores as predictors of morbidity and mortality in colorectal surgery. ACTA ACUST UNITED AC 2018; 45:e1347. [PMID: 29451643 DOI: 10.1590/0100-6991e-20181347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/21/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE to apply the POSSUM and P-POSSUM scores as a tool to predict morbidity and mortality in colorectal surgery. METHODS we conducted a prospective cohort study of 551 patients submitted to colorectal surgery in a colorectal surgery tertiary referral hospital in Brazil. We grouped patients into pre-established risk categories for comparison between expected and observed morbidity and mortality rates by the POSSUM and P-POSSUM scores. RESULTS in the POSSUM morbidity analysis, the overall expected morbidity was significantly higher than that observed (39.2% vs. 15.6%). The same occurred with patients grouped in categories II (28.9% x 10.5) and III (64.6% x 24.5%). In category I, the expected and observed morbidities were similar (13.7% x 9.1%). Regarding the evaluation of mortality, it was statistically higher than that observed in category III patients and in the total number of patients (11.3% vs. 5.6%). In categories I and II, we observed the same pattern of category III, but without statistical significance. When evaluating mortality by the P-POSSUM score, the overall expected and observed mortality was similar (5.8% x 5.6%). Of the 31 patients who died, 20.2% underwent emergency procedures and sepsis was the main cause of death. CONCLUSION the P-POSSUM score was an accurate tool to predict mortality and could be safely used in this population profile, unlike the POSSUM score.
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Caglià P, Tracia A, Buffone A, Amodeo L, Tracia L, Amodeo C, Veroux M. Physiopathology and clinical considerations of laparoscopic surgery in the elderly. Int J Surg 2016; 33 Suppl 1:S97-S102. [PMID: 27255126 DOI: 10.1016/j.ijsu.2016.05.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The marked improvements in medical technology and healthcare, lead an increasing number of elderly patients to take advantage of even complex surgical. Recently, laparoscopic surgery has been accepted as a minimally invasive treatment to reduce the morbidity after conventional surgery, and a number of studies have demonstrated the feasibility of laparoscopy with significant advantages also in the elderly. On the other side, the laparoscopic procedure has some drawbacks, including prolonged operation time and impact of carbon dioxide pneumoperitoneum on circulatory and respiratory dynamics. This paper will review the physiopathological implications of laparoscopy, as well as the current literature concerning the most common laparoscopic procedures that are increasingly performed in elderly patients. MATERIALS AND METHODS A systematic review of the current literature was performed using the search engines EMBASE and PubMed to identify all studies reporting the physiopathological implications of laparoscopy in the elderly. The MeSH search terms used were "laparoscopy in the elderly", "physiopathology of laparoscopy", and "pneumoperitoneum". Multiple combinations of the keywords and MeSH terms were used with particular reference to elderly patients. RESULTS Although laparoscopy is minimally invasive in its dissection techniques, the increased physiologic demands present particular challenges among elderly patients. CONCLUSIONS Laparoscopy and its safety in the elderly patients remains a challenge and the evaluation of this approach is therefore mandatory. Although many studies have demonstrated the applicability and advantages of the laparoscopy also in the geriatric population, with low rates of morbidity and mortality, in elderly patients undergoing general surgical procedures the physiologic demands of laparoscopy should be carefully considered.
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Affiliation(s)
- Pietro Caglià
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Angelo Tracia
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Antonino Buffone
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Luca Amodeo
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Luciano Tracia
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Corrado Amodeo
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
| | - Massimiliano Veroux
- Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy.
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González-Martínez S, Martín-Baranera M, Martí-Saurí I, Borrell-Grau N, Pueyo-Zurdo JM. Comparison of the risk prediction systems POSSUM and P-POSSUM with the Surgical Risk Scale: A prospective cohort study of 721 patients. Int J Surg 2016; 29:19-24. [PMID: 26970177 DOI: 10.1016/j.ijsu.2016.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/03/2016] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The outcomes of surgery are subject to variability and difficult to be accurately predicted. Different score systems have been developed to estimating the risk of undergoing a surgical procedure. The aim of this study was to assess the predictive ability of POSSUM and P-POSSUM scoring systems, compared to the Surgical Risk Scale (SRS), in Spanish patients undergoing general surgery. PATIENTS AND METHODS In this prospective observational study, 721 consecutive patients needing a surgical procedure were included. Observed morbidity and mortality after surgery were compared to the expected ones obtained by applying POSSUM, P-POSSUM and SRS. RESULTS Mean age was 59.2 years (standard deviation (SD): 17.4 years), 43.5% were women. 616 (85.5%) patients underwent elective general surgery and 105 (14.5%) emergency surgery. The 30-day morbidity was 15.4%. The reintervention rate was 2.1% and mortality was 2.1%. The discrimination ability was excellent in predicting mortality. The Area Under the Curve (AUC) values were: POSSUM: AUC = 0.97, C.I.95%: 0.948-0.992, p < 0.0001; P-POSSUM: AUC = 0.966, C.I.95%: 0.941-0.991, p < 0.0001; SRS: AUC = 0.91, C.I.95%:0.853-0.967, p < 0.0001. POSSUM was also discriminative in the prediction of morbidity (AUC = 0.772, C.I.95%: 0.719-0.826, p < 0.0001). POSSUM predicted morbidity and mortality were higher than the observed ones (p = 0.01 and p = 0.04). Predicted and observed mortality were very similar for P-POSSUM (p = 0.93) and SRS (p = 0.37). CONCLUSIONS Expected morbidity and mortality determined by POSSUM score showed values significantly above the observed ones. P-POSSUM and SRS systems were effective in predicting mortality. The SRS application is simple and may contribute to appropriate medical decision making.
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Affiliation(s)
- Sergio González-Martínez
- Department of Surgery, Hospital Moises Broggi, Consorci Sanitari Integral, C/Jacinto Verdaguer 90, E-08970, Sant Joan Despi, Barcelona, Spain.
| | - Montserrat Martín-Baranera
- Department of Clinical Epidemiology, Consorci Sanitari Integral, Av. Josep Molins 29-41, E-08906, L'hospitalet de Llobregat, Barcelona, Spain.
| | - Isidro Martí-Saurí
- Department of Surgery, Hospital Moises Broggi, Consorci Sanitari Integral, C/Jacinto Verdaguer 90, E-08970, Sant Joan Despi, Barcelona, Spain
| | - Nuria Borrell-Grau
- Clinical Nursing, Hospital Dos de Maig, Consorci Sanitari Integral, C/Dos de Maig 301, E-08025, Barcelona, Spain.
| | - José M Pueyo-Zurdo
- Department of Surgery Hospital Dos de Maig, Consorci Sanitari Integral, C/Dos de Maig 301, E-08025, Barcelona, Spain.
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15
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Takama T, Okano K, Kondo A, Akamoto S, Fujiwara M, Usuki H, Suzuki Y. Predictors of postoperative complications in elderly and oldest old patients with gastric cancer. Gastric Cancer 2015; 18:653-61. [PMID: 24874161 DOI: 10.1007/s10120-014-0387-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/05/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The incidence of gastric cancer has been increasing among elderly persons in Japan. This study aimed to clarify risk factors for postoperative complications in oldest old patients with gastric cancer. METHODS One-hundred ninety patients more than 75 years old with gastric cancer underwent gastrectomy between 2000 and 2011. Patients were classified into two groups: group A included 29 patients who were 85 years or older (oldest old patients), and group B included 161 patients who were 75-84 years of age. Perioperative parameters associated with complications were compared in each group. RESULTS The preoperative estimated glomerular filtration rate was significantly lower in group A (p = 0.03). The two groups significantly differed in performance status (p = 0.018). Patients in group A received a lesser extent of lymph node dissection and had fewer lymph nodes excised. As a result, the duration of the operation was significantly shorter in group A. There were no significant differences in the frequency or grade of total complications or mortality between the two groups. Operative hemorrhage (>300 ml) and Hiroshima POSSUM (predicted morbidity risk >40) were risk factors in both groups A and B; the risk factors of preoperative serum albumin level and prognostic nutritional index (PNI) were specific to group A. CONCLUSIONS Adjustments to the extent of surgery among oldest old patients most likely reduces the incidence of postoperative complications in this group. Preoperative serum albumin level and PNI are significant predictors of postoperative complications in oldest old patients with gastric cancer.
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Affiliation(s)
- Takehiro Takama
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
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16
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Chatterjee AS, Renganathan D. POSSUM: A Scoring System for Perforative Peritonitis. J Clin Diagn Res 2015; 9:PC05-9. [PMID: 26046021 PMCID: PMC4437105 DOI: 10.7860/jcdr/2015/12720.5854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/23/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Perforative peritonitis carries considerable morbidity and mortality with the postoperative period unpredictable most of the times. It therefore becomes necessary for a scoring system that predicts the post-operative outcome. POSSUM (Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity) helps in predicting the post-operative morbidity and mortality in these patients. POSSUM scores are based on 12 physiological factors and 6 operative factors. In our study, we included two more factors, which are specifically important in perforative peritonitis; they are, perforation to operation time and the presence of co-morbidity. The presence of these factors significantly affects the post-operative status. Through this prospective study, we can predict which patients are at a higher risk of death or complication and give appropriate management as necessary. MATERIALS AND METHODS Our sample size was 50 patients with perforative peritonitis. The study was conducted in single unit from September 2013 to August 2014. Data was collected based on POSSUM scoring system. Outcome of the patients was recorded as death / alive; complicated / uncomplicated and statistical analysis was done by comparing the expected and observed outcomes. RESULTS By applying linear analysis, an observed to expected ratio of 1.005 was obtained for mortality and 1.001 for morbidity. There was no statistically significant difference between the observed and expected mortality rates (χ(2) = 3.54, p = 0.316) and morbidity rates (χ(2) = 2.40, p = 0.792). It was found to be comparable with other studies. The factors independently studied; perforation to operation time and presence of co-morbidity were statistically significant with respect to outcome (p<0.05). CONCLUSION Although a small sample size is the limitation of this study, POSSUM scoring system is a good indicator of postoperative outcome in patients with perforative peritonitis and was applicable in our setup. It is useful in identifying high risk patients and give preferential care to them for better outcome. Inclusion of factors like perforation to operation time and co-morbid status can improve the scoring system and better care can be provided.
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Affiliation(s)
- Ambarish S. Chatterjee
- Registrar, Department of General Surgery, Seth V.C. Gandhi & M.A. Vora Municipal General Hospital, Rajawadi, Ghatkopar (E), Mumbai- Maharashtra, India
| | - D.N. Renganathan
- Professor, Department of General Surgery, Coimbatore Medical College, Coimbatore, Tamil Nadu, India
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17
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van der Sluis FJ, Espin E, Vallribera F, de Bock GH, Hoekstra HJ, van Leeuwen BL, Engel AF. Predicting postoperative mortality after colorectal surgery: a novel clinical model. Colorectal Dis 2014; 16:631-9. [PMID: 24506067 DOI: 10.1111/codi.12580] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 12/15/2013] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to develop and externally validate a clinically, practical and discriminative prediction model designed to estimate in-hospital mortality of patients undergoing colorectal surgery. METHOD All consecutive patients who underwent elective or emergency colorectal surgery from 1990 to 2005, at the Zaandam Medical Centre, The Netherlands, were included in this study. Multivariate logistic regression analysis was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) linking the explanatory variables to the outcome variable in-hospital mortality, and a simplified Identification of Risk in Colorectal Surgery (IRCS) score was constructed. The model was validated in a population of patients who underwent colorectal surgery from 2005 to 2011 in Barcelona, Spain. Predictive performance was estimated by calculating the area under the receiver operating characteristic curve. RESULTS The strongest predictors of in-hospital mortality were emergency surgery (OR = 6.7, 95% CI 4.7-9.5), tumour stage (OR = 3.2, 95% CI 2.8-4.6), age (OR = 13.1, 95% CI 6.6-26.0), pulmonary failure (OR = 4.9, 95% CI 3.3-7.1) and cardiac failure (OR = 3.7, 95% CI 2.6-5.3). These parameters were included in the prediction model and simplified scoring system. The IRCS model predicted in-hospital mortality and demonstrated a predictive performance of 0.83 (95% CI 0.79-0.87) in the validation population. In this population the predictive performance of the CR-POSSUM score was 0.76 (95% CI 0.71-0.81). CONCLUSIONS The results of this study have shown that the IRCS score is a good predictor of in-hospital mortality after colorectal surgery despite the relatively low number of model parameters.
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Affiliation(s)
- F J van der Sluis
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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18
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Charalampakis V, Wiglesworth A, Formela L, Senapati S, Akhtar K, Ammori B. POSSUM and p-POSSUM overestimate morbidity and mortality in laparoscopic bariatric surgery. Surg Obes Relat Dis 2014; 10:1147-53. [PMID: 25205569 DOI: 10.1016/j.soard.2014.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 03/02/2014] [Accepted: 04/09/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite their wide use in surgical audit, the application of the Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and the Portsmouth predictor of mortality (p-POSSUM) in bariatric surgery has been limited. The aim of this study was to evaluate the usefulness of POSSUM and p-POSSUM in bariatric comparative audit. METHODS Data were retrospectively collected on consecutive patients who underwent laparoscopic gastric by-pass (LRYGB) and sleeve gastrectomy (SG) at a teaching institute. POSSUM and p-POSSUM equations were applied. The observed to expected ratios for morbidity and mortality were calculated. A Student's t test was performed to assess if a relationship could be found between the observed and the predicted outcomes. RESULTS Between 2008 and 2013, 504 patients (370 female) with a mean (range) age of 46 (17-69) years underwent LRYGB (n = 383) and SG (n = 121). The operative morbidity was 10.9% and mortality was .2%. POSSUM overpredicted morbidity (30.56%), and no relationship between morbidity risk and the development of complications was found (P = .152). There was a grouping of patients in the low-risk mortality groups for both POSSUM and p-POSSUM. Both equations overpredicted mortality (5.95% and 1.62%, respectively). CONCLUSION Both POSSUM and p-POSSUM equations overpredicted morbidity and mortality in this only study in the literature of modern bariatric practice that employed a large representative patient sample receiving the commonest procedures. A multicenter study is needed to address the low incidence of events and enable modification of those equations for use in bariatric surgical audit.
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Affiliation(s)
| | - Amanda Wiglesworth
- Department of Surgery at Salford Royal Foundation Trust, Manchester, United Kingdom; The University of Manchester, Manchester, United Kingdom
| | - Laura Formela
- Department of Surgery at Salford Royal Foundation Trust, Manchester, United Kingdom
| | - Siba Senapati
- Department of Surgery at Salford Royal Foundation Trust, Manchester, United Kingdom
| | - Khurshid Akhtar
- Department of Surgery at Salford Royal Foundation Trust, Manchester, United Kingdom
| | - Basil Ammori
- Department of Surgery at Salford Royal Foundation Trust, Manchester, United Kingdom; The University of Manchester, Manchester, United Kingdom.
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19
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Montroni I, Ghignone F, Rosati G, Zattoni D, Manaresi A, Taffurelli M, Ugolini G. The challenge of education in colorectal cancer surgery: a comparison of early oncological results, morbidity, and mortality between residents and attending surgeons performing an open right colectomy. JOURNAL OF SURGICAL EDUCATION 2014; 71:254-261. [PMID: 24602718 DOI: 10.1016/j.jsurg.2013.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/04/2013] [Accepted: 08/09/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Ongoing education in surgical oncology is mandatory in a modern residency program. Achieving acceptable morbidity and mortality rates, together with oncological adequacy, is mandatory. The aim of the study was to compare early surgical outcomes in 2 groups of patients, those operated on by a surgical resident supervised by an attending surgeon and those operated on by 2 attending surgeons. DESIGN Data from consecutive patients with right colon cancer undergoing a right hemicolectomy were collected and analyzed. The patients were divided into 2 groups according to the surgeons' credentials: residents supervised by an attending surgeon and 2 attending surgeons. To evaluate the specific case mix of the 2 groups, the Portsmouth-Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (P-POSSUM) was calculated. Observed over expected 30-day morbidity and mortality rates were compared for the 2 groups. The number of lymph nodes retrieved was chosen to determine oncological appropriateness. Duration of the procedures was also recorded. RESULTS From January 2008 to January 2012, 139 patients underwent an right hemicolectomy (76 resections performed by surgical residents and 63 by attending surgeons). Patient characteristics according to the P-POSSUM score and cancer stage were equivalent in the 2 groups. Observed over expected mortality and morbidity rates according to P-POSSUM were 0%/3.5% and 21.6%/40.5%, respectively, for the resident group (p = nonsignificant, p = 0.01) and 4.7%/5.8% and 25.4%/42.9%, respectively, for the attending surgeons (p = nonsignificant). The node count was 23.6 nodes for residents and 23.1 for the attending surgeons. The length of surgery was 159.9 minutes vs 159.4 minutes for residents and attending surgeons, respectively. CONCLUSIONS Surgical oncology training of residents by expert surgeons cannot put patient's safety at risk. Our study showed that oncological accuracy and the 30-day complication rate were equivalent to the standard of care in both groups. Duration of the procedure was not affected by the presence of a trainee.
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Affiliation(s)
- Isacco Montroni
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Italy.
| | - Federico Ghignone
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Italy
| | - Giancarlo Rosati
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Italy
| | - Davide Zattoni
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Italy
| | - Alessio Manaresi
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Italy
| | - Mario Taffurelli
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Italy
| | - Giampaolo Ugolini
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Italy
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McNamee P, Shenfine J, Bond J. Measuring quality of life and utilities in esophageal cancer. Expert Rev Pharmacoecon Outcomes Res 2014; 3:179-88. [DOI: 10.1586/14737167.3.2.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Ugolini G, Montroni I, Rosati G, Ghignone F, Bacchi-Reggiani ML, Belluzzi A, Castellani L, Taffurelli M. Can POSSUM accurately predict post-operative complications risk in patients with abdominal Crohn's disease? ANZ J Surg 2013; 84:78-84. [DOI: 10.1111/ans.12297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 01/24/2023]
Affiliation(s)
- Giampaolo Ugolini
- Department of Medical and Surgical Sciences; University of Bologna, Policlinico S.Orsola-Malpighi; Bologna Italy
| | - Isacco Montroni
- Department of Medical and Surgical Sciences; University of Bologna, Policlinico S.Orsola-Malpighi; Bologna Italy
| | - Giancarlo Rosati
- Department of Medical and Surgical Sciences; University of Bologna, Policlinico S.Orsola-Malpighi; Bologna Italy
| | - Federico Ghignone
- Department of Medical and Surgical Sciences; University of Bologna, Policlinico S.Orsola-Malpighi; Bologna Italy
| | - Maria Letizia Bacchi-Reggiani
- Department of Specialised, Experimental, and Diagnostic Medicine; University of Bologna, Policlinico S.Orsola-Malpighi; Bologna Italy
| | - Andrea Belluzzi
- Department of Specialised, Experimental, and Diagnostic Medicine; University of Bologna, Policlinico S.Orsola-Malpighi; Bologna Italy
| | - Lucia Castellani
- Department of Specialised, Experimental, and Diagnostic Medicine; University of Bologna, Policlinico S.Orsola-Malpighi; Bologna Italy
| | - Mario Taffurelli
- Department of Medical and Surgical Sciences; University of Bologna, Policlinico S.Orsola-Malpighi; Bologna Italy
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22
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Merad F, Baron G, Pasquet B, Hennet H, Kohlmann G, Warlin F, Desrousseaux B, Fingerhut A, Ravaud P, Hay JM. Prospective Evaluation of In-hospital Mortality with the P-POSSUM Scoring System in Patients Undergoing Major Digestive Surgery. World J Surg 2012; 36:2320-7. [DOI: 10.1007/s00268-012-1683-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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[Adverse events in general surgery. A prospective analysis of 13,950 consecutive patients]. Cir Esp 2011; 89:599-605. [PMID: 21871615 DOI: 10.1016/j.ciresp.2011.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Revised: 06/21/2011] [Accepted: 06/24/2011] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Adverse event (AE) rates in General Surgery vary, according to different authors and recording methods, between 2% and 30%. Six years ago we designed a prospective AE recording system to change patient safety culture in our Department. We present the results of this work after a 6 year follow-up. MATERIAL AND METHOD The AE, sequelae and health care errors in a University Hospital surgery department were recorded. An analysis of each incident recorded was performed by a reviewer. The data was entered into data base for rapid access and consultation. The results were routinely presented in Departmental morbidity-mortality sessions. RESULTS A total of 13,950 patients had suffered 11,254 AE, which affected 5142 of them (36.9% of admissions). A total of 920 patients were subjected to at least one health care error (6.6% of admissions). This meant that 6.6% of our patients suffered an avoidable AE. The overall mortality at 5 years in our department was 2.72% (380 deaths). An adverse event was implicated in the death of the patient in 180 cases (1.29% of admissions). In 49 cases (0.35% of admissions), mortality could be attributed to an avoidable AE. After 6 years there tends to be an increasingly lower incidence of errors. CONCLUSIONS The exhaustive and prospective recording of AE leads to changes in patient safety culture in a Surgery Department and helps decrease the incidence of health care errors.
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Leung E, Ferjani AM, Kitchen A, Griffin D, Stellard N, Wong LS. Risk-adjusted scoring systems can predict surgeons’ performance in colorectal surgery. Surgeon 2011; 9:3-7. [PMID: 21195323 DOI: 10.1016/j.surge.2010.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 07/16/2010] [Accepted: 07/16/2010] [Indexed: 11/29/2022]
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Pirlet IA, Slim K, Kwiatkowski F, Michot F, Millat BL. Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial. Surg Endosc 2010; 25:1814-21. [PMID: 21170659 DOI: 10.1007/s00464-010-1471-6] [Citation(s) in RCA: 215] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Accepted: 11/02/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical management of left colonic cancer presenting as an acute obstruction remains controversial and still is associated with high mortality and morbidity rates. Recently, self-expandable metallic stents (SEMS) have been used as a bridge to surgery in an attempt to decompress the colon and then allow elective one-stage surgical resection without stoma placement. This study aimed to compare the outcomes of emergency surgery alone with emergency placement of colonic SEMS as a bridge to surgery in terms of efficiency and reduction of the stoma placement rate. METHODS A multicenter prospective, randomized, controlled trial was conducted according to the consolidated standards of reporting trials (CONSORT) Statement criteria. Patients eligible for the study were randomized to either emergency surgery or emergency SEMS as a bridge to surgery. The primary outcome was the need for a stoma (temporary or permanent) for any reason. The secondary end points were mortality, morbidity, and length of hospital stay. RESULTS Nine centers participated in the trial. Among the 70 patients eligible for the study, 60 were randomized and included for the final analysis, 30 patients in each group. Seven patients were randomized but did not fulfill the entry requirements, whereas three further eligible patients were not randomized for various reasons. Concerning the primary outcome, 17 patients in the surgery group sustained a stoma placement versus 13 patients in the SEMS group (p=0.30). No statistically significant difference was noted concerning the secondary outcomes. A total of 16 attempts at SEMS placement (53.3%) were technical failures. Two colonic perforations directly related to the stent placement procedure occurred among the 30 randomized patients and 1 perforation occurred among the nonrandomized patients, leading to premature closure of inclusions in the study before the expected number of 80 patients was reached. CONCLUSION This randomized trial failed to demonstrate that emergency preoperative SEMS for patients presenting with acute left-sided malignant colonic obstruction could significantly decrease the need for stoma placement.
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Affiliation(s)
- Isabelle A Pirlet
- Digestive Surgery Unit, Hôpital Saint Eloi, Montpellier University Hospital, Montpellier Cedex 5, France
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Morbidity and mortality following colorectal surgery in patients with end-stage renal failure: a population-based study. Dis Colon Rectum 2010; 53:1508-16. [PMID: 20940599 DOI: 10.1007/dcr.0b013e3181e8fc8e] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The risk of abdominal surgery in patients with end-stage renal failure is poorly defined. Our objective was to describe outcomes of colorectal surgery in dialysis patients from a population-based perspective. METHODS We analyzed the 1993 to 2007 Nationwide Inpatient Sample to identify patients hospitalized for colorectal surgery. The effect of renal failure on mortality, complications, length of stay, and charges was evaluated using logistic regression models. RESULTS Between 1993 and 2007, there were 755,343 admissions for colorectal surgery in the Nationwide Inpatient Sample database; 5806 patients (0.77%) were receiving dialysis treatment (87.4% hemodialysis, 4.9% peritoneal dialysis, 7.7% method not specified). Patients undergoing dialysis had an increased risk of mortality (22.1% vs 2.8%; adjusted OR 4.83; 95% CI 4.58-5.31) and complications (52.1% vs 34.0%; adjusted OR 2.04; 95% CI 1.90-2.17). Dialysis patients undergoing nonelective procedures had a 2-fold higher mortality rate than patients having had elective surgery (25.5% vs 10.3%; adjusted OR 2.01; 95% CI 1.65-2.43). In nonelective surgery, independent predictors of mortality included procedures with an end-stoma (adjusted OR 1.86; 95% CI 1.58-2.18), age over 60 (adjusted OR 1.73; 95% CI 1.43-2.08), total colectomy (adjusted OR 1.68; 95% CI 1.27-2.22), vascular insufficiency as surgical indication (adjusted OR 1.58; 95% CI 1.32-1.90), nonprivate insurance coverage (adjusted OR 1.38; 95% CI 1.07-1.77) and malnutrition (adjusted OR 1.26; 95% CI 1.01-1.59). CONCLUSIONS Patients receiving dialysis treatment have an increased risk of morbidity and mortality following colorectal surgery. Elective procedures are associated with a 10% rate of mortality in this population. Dialysis patients are especially susceptible to infectious and pulmonary complications after colorectal resection. Additional studies are necessary to refine risk stratification in this high-risk patient population.
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Richards CH, Leitch FE, Horgan PG, McMillan DC. A systematic review of POSSUM and its related models as predictors of post-operative mortality and morbidity in patients undergoing surgery for colorectal cancer. J Gastrointest Surg 2010; 14:1511-20. [PMID: 20824372 DOI: 10.1007/s11605-010-1333-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 08/12/2010] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) model and its Portsmouth (P-POSSUM) and colorectal (CR-POSSUM) modifications are used extensively to predict and audit post-operative mortality and morbidity. This aim of this systematic review was to assess the predictive value of the POSSUM models in colorectal cancer surgery. METHODS Major electronic databases, including Medline, Embase, Cochrane Library and Pubmed were searched for original studies published between 1991 and 2010. Two independent reviewers assessed each study against inclusion and exclusion criteria. All data was specific to colorectal cancer surgery. Predictive value was assessed by calculating observed to expected (O/E) ratios. RESULTS Nineteen studies were included in final review. The mortality analysis included ten studies (4,799 patients) on POSSUM, 17 studies (6,576 patients) on P-POSSUM and 14 studies (5,230 patients) on CR-POSSUM. Weighted O/E ratios for mortality were 0.31 (CI 0.31-0.32) for POSSUM, 0.90 (CI 0.88-0.92) for P-POSSUM and 0.64 (CI 0.63-0.65) for CR-POSSUM. The morbidity analysis included four studies (768 patients) on POSSUM with a weighted O/E ratio of 0.96 (CI 0.94-0.98). CONCLUSIONS P-POSSUM was the most accurate model for predicting post-operative mortality after colorectal cancer surgery. The original POSSUM model was accurate in predicting post-operative complications.
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Affiliation(s)
- Colin Hewitt Richards
- University Department of Surgery, Faculty of Medicine-University of Glasgow, Royal Infirmary, Glasgow G4 0SF, UK.
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Abbas SM, Kahokehr A, Mahmoud M, Hill AG. The Simple Prognostic Index (SPI)—A Pathophysiologic Prognostic Scoring Tool for Emergency Laparotomy. J Surg Res 2010; 163:e59-65. [DOI: 10.1016/j.jss.2010.04.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 03/23/2010] [Accepted: 04/27/2010] [Indexed: 11/29/2022]
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Laparoscopic colorectal surgery produces better outcomes for high risk cancer patients compared to open surgery. Ann Surg 2010; 252:84-9. [PMID: 20562603 DOI: 10.1097/sla.0b013e3181e45b66] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES The excellent outcomes reported for laparoscopic colorectal surgery in selected patients could also be potentially advantageous for high risk patients. This prospective study was designed to examine the feasibility and safety of laparoscopic resection in high risk patients with colorectal cancer. METHODS Between 2006 and 2008 consecutive patients undergoing elective surgery for colorectal cancer were stratified into high and low risk groups. High risk was defined as >or=80 years, American Society of Anesthesiologists >or=3, preoperative radiotherapy, T4 tumor and BMI >or=30. Outcomes included median length of stay, lymph node yield, resection margins, 30-day hospital readmission, postoperative mortality and major postoperative complications requiring reoperation within 30 days of surgery. RESULTS A total of 424 patients underwent elective laparoscopic (224) and open (200) resections. Overall mortality rate for laparoscopic resection was 1 of 224 (0.4%) versus 4 of 200 (2%) for open resection. Median length of stay was 4 (2-33) versus 10 (1-69) days (P < 0.0001), and rate of complications requiring reoperation was 2 of 224 (0.8%) compared with 10 of 200 (5%) (P = 0.02).Among the 280 (66%) "high risk" patients, 146 had laparoscopic resection (8 conversions; 5%) and 134 had open resections. Median hospital stay was 4 (2-33) days in the laparoscopic group versus 11 (1-69) days in the open group (P < 0.0001). Complications requiring reoperation were 2 of 146 (1.4%) after laparoscopic resection versus 7 of 134 (5.2%) after open resection (P < 0.09). Readmission rate after laparoscopic resection was 12.3% versus 5.2% after open resection (P = 0.06). CONCLUSION Laparoscopic resection of colorectal cancer can achieve excellent results even in "high risk" patients and is associated with significant reductions in length of stay compared with open resection.
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Ugolini G, Rosati G, Montroni I, Manaresi A, Blume JF, Schifano D, Zattoni D, Taffurelli M. A Preliminary Audit Experience of Surgery for Rectal Cancer after Neoadjuvant Chemoradiation Therapy. TUMORI JOURNAL 2010; 96:260-5. [DOI: 10.1177/030089161009600212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background A surgical audit is a systematic critical analysis of surgical performance, with the goal to improve the quality of patient care. Rectal cancer surgery is one of the most delicate procedures in the field of surgical oncology, with significant variations in terms of complications from center to center. Neoadjuvant chemoradiation therapy leads to a significant reduction in local recurrences in patients with locally advanced lower and medium rectal cancer. The aim of the study was to evaluate the influence of neoadjuvant chemoradiation therapy on postoperative morbidity and mortality in patients with rectal cancer. Methods and study design From January 1,2003, to December 31, 2007, patients who underwent elective surgical resection for lower and medium rectal cancer in our Surgical Unit were prospectively analyzed. Patients (n = 42) were divided into two groups: 1) those treated with neoadjuvant chemotherapy and consequent surgical resection (19/42); 2) those treated with primary surgical treatment (23/42). P-POSSUM (Portsmouth Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity) and CR-POSSUM (ColoRectal-POSSUM) scores were calculated for each patient group. Thirty-day mortality and morbidity rates were prospectively collected in a comprehensive data base. Data were evaluated by comparing the predictions of the two scoring systems in both study groups with clinically observed mortality and morbidity rates. Results In group 1, no death was registered (0/19). The P-POSSUM and CR-POSSUM expected mortality was 2.43% and 4.52%, respectively (P >0.05). In group 2, a single death was documented (1/23, 4.35%). The P-POSSUM and CR-POSSUM expected mortality was 2.1% and 4.94%, respectively. The postoperative complications rate for group 1 was 10.52% (2/19) compared to 34.88% as expected from the P-POSSUM score (P <0.05). In group 2, a postoperative complication rate of 39.13% (9/23) was observed compared to 34.26% as expected from the P-POSSUM score (P >0.05). Conclusions No significant influence on morbidity or mortality was detected in patients who underwent neoadjuvant radio-chemotherapy.
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Affiliation(s)
- Giampaolo Ugolini
- Department of General Surgery, Emergency and Organ Transplantation, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna
| | - Giancarlo Rosati
- Department of General Surgery, Emergency and Organ Transplantation, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna
| | - Isacco Montroni
- Department of General Surgery, Emergency and Organ Transplantation, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna
| | - Alessio Manaresi
- Department of General Surgery, Emergency and Organ Transplantation, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna
| | | | - Domenico Schifano
- Department of General Surgery, Emergency and Organ Transplantation, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna
| | - Davide Zattoni
- Department of General Surgery, Emergency and Organ Transplantation, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna
| | - Mario Taffurelli
- Department of General Surgery, Emergency and Organ Transplantation, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna
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Ugolini G, Rosati G, Montroni I, Zanotti S, Manaresi A, Giampaolo L, Blume JF, Taffurelli M. Can elderly patients with colorectal cancer tolerate planned surgical treatment? A practical approach to a common dilemma. Colorectal Dis 2009; 11:750-5. [PMID: 19708094 DOI: 10.1111/j.1463-1318.2008.01676.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Analysing the effectiveness of a surgical procedure is mandatory in every modern health-care system. The aging of the population stresses the need for a good standard of care. This study tests the hypothesis that porthsmouth-physiologic operative severity score for enumeration of morbidity and mortality (P-POSSUM) and colorectal-POSSUM (CR-POSSUM) would be useful clinical auditing tools in colorectal cancer surgery for aged patients. METHOD One hundred and seventy-seven consecutive patients over 70 years of age underwent emergency or elective surgery from January 2003 to December 2005. Demographic, clinical and surgical information, score systems' prediction, complications and 30-day mortality data were prospectively entered in a comprehensive database. The observed over expected morbidity and mortality rate was calculated. RESULTS Thirty-day observed mortality was 10.3% (19/177) while P-POSSUM and CR-POSSUM expected mortality were, respectively, 11.21% (P = NS) and 13.08% (P = NS). Overall observed morbidity was 42.7%, P-POSSUM prediction was 59.3% (P = 0.002). Morbidity and mortality data were analysed for specific subgroups of patients (resection and anastomosis/resection and stoma/palliative; emergency/elective). CONCLUSION P-POSSUM and CR-POSSUM are useful tools to predict mortality in elderly patients. P-POSSUM significantly overestimated the risk of complications. A more accurate tool for preoperative assessment for aged patients is probably needed to predict the post-surgical outcome.
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Affiliation(s)
- G Ugolini
- Department of General Surgery, Emergency Surgery and Organ Transplantation, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
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Ramesh VJ, Umamaheswara Rao GS, Guha A, Thennarasu K. Evaluation of POSSUM and P-POSSUM scoring systems for predicting the mortality in elective neurosurgical patients. Br J Neurosurg 2009; 22:275-8. [DOI: 10.1080/02688690701784905] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mortality rate prediction by Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM), Portsmouth POSSUM and Colorectal POSSUM and the development of new scoring systems in Chinese colorectal cancer patients. Am J Surg 2009; 198:31-8. [DOI: 10.1016/j.amjsurg.2008.06.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Revised: 06/24/2008] [Accepted: 06/24/2008] [Indexed: 11/24/2022]
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Ugolini G, Rosati G, Montroni I, Zanotti S, Manaresi A, Giampaolo L, Taffurelli M, Pricolo V. An easy-to-use solution for clinical audit in colorectal cancer surgery. Surgery 2008; 145:86-92. [PMID: 19081479 DOI: 10.1016/j.surg.2008.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Accepted: 07/07/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinical audit has been increasingly required for the accreditation process in every modern healthcare system. Data collection and analysis are excessively time-consuming in everyday practice. The primary aim of our study was to evaluate the effectiveness of an innovative database to assist surgeons in monitoring clinical practice outcomes in colorectal cancer surgery. The second purpose was to compare observed mortality rates to 3 risk-predicting operative scoring systems. METHODS Data were evaluated from 208 consecutive patients undergoing elective and emergency surgery for colorectal cancer over a 2-year period (2003-2004). A new database was developed with specific queries to compare the observed and the expected mortality rates according to 3 scoring systems: the Portsmouth-Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (P-POSSUM), the ColoRectal-Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (CR-POSSUM), and the Association of ColoProctology or Great Britain & Ireland (ACPGBI) score. Results were discussed at regular intervals. Surgeons' satisfaction with each system was evaluated with a questionnaire. RESULTS The observed mortality rate was 6.25%, which was significantly lower than the values predicted by CR-POSSUM and ACPGBI colorectal scores (9.14% and 19.42%, respectively; P < .05). P-POSSUM was the most accurate predictor of mortality, with a value of 7.93%. A total of 80% of the surgical staff considered this type of surgical audit activity as clinically useful. CONCLUSION The study confirms the usefulness of a dedicated database in a surgical audit activity. The ACPGBI colorectal score largely overestimated 30-day mortality in our experience.
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Affiliation(s)
- Giampaolo Ugolini
- Department of General Surgery, Emergency Surgery and Organ Transplantation, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
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Can MF, Yagci G, Tufan T, Ozturk E, Zeybek N, Cetiner S. Can SAPS II predict operative mortality more accurately than POSSUM and P-POSSUM in patients with colorectal carcinoma undergoing resection? World J Surg 2008; 32:589-95. [PMID: 18204950 DOI: 10.1007/s00268-007-9321-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study assessed the APACHE II (Acute Physiology and Chronic Health Evaluation II), SAPS II (Simplified Acute Physiology Score-II), POSSUM (Physiologic and Operative Severity Score for Enumeration of Morbidity and Mortality), and P-POSSUM (Portsmouth-POSSUM) in patients with colorectal cancer undergoing curative or palliative resection. METHODS Predicted mortality rates and the observed/expected mortality ratio were computed by means of each scoring system. The results were compared between survivors and nonsurvivors and between elective and emergency operations. Each model was assessed for its accuracy to predict the risk of death using receiver operator characteristic (ROC) curve analysis, and risk stratification was generated as well. RESULTS Some 224 patients were enrolled in the study. The overall 30-day mortality rate was 3.6% (n = 8). Predicted mortality rates generated by APACHE II, SAPS II, POSSUM, and P-POSSUM were 9.1%, 3.7%, 13.4%, and 5.2%, respectively. All the scoring systems assigned higher scores to those patients who died than to those who survived. Areas under the curve calculated by ROC curve analysis for APACHE II, SAPS II, POSSUM, and P-POSSUM were 0.786, 0.854, 0.793, and 0.831, respectively. Best stratification was achieved by the SAPS II score. CONCLUSIONS SAPS II and P-POSSUM were determined to be better predictors for patients with colorectal cancer undergoing resection. SAPS II also was found to have a higher degree of discriminatory power in colorectal resection for carcinoma. The predictive value of this useful severity score in several surgical subgroups must be examined to evaluate its routine use in risk-adjusted audit.
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Affiliation(s)
- Mehmet F Can
- Department of Surgery, Gulhane School of Medicine, 06018 Etlik, Ankara, Turkey.
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Evaluation of POSSUM scoring system in the treatment of osteoporotic fracture of the hip in elder patients. Chin J Traumatol 2008; 11:89-93. [PMID: 18377711 DOI: 10.1016/s1008-1275(08)60019-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To evaluate the applicability of the modified physiological and operative severity score for enumeration of mortality and morbidity (POSSUM) scoring system in predicting mortality in the patients undergoing hip joint arthroplasty. METHODS A total of 295 patients with hip fractures were analyzed using the modified POSSUM surgical scoring system. The mean ages of the patients were 66.59 years in the complicative group, 62.28 years in noncomplicative group, 77.89 years in the death group and 63.25 years in the living group, respectively. The comparisons between the observed and predicted morbidity, between the observed and predicted mortality were made within 30 days after operation. RESULTS The average physiological scores and operative severity scores was 18.96+/-4.83 and 13.47+/-2.01 in complicative group, while 15.65+/-3.66 and 11.74+/-2.26 in noncomplicative group (P less than 0.05). The average physiological scores and operative severity scores was 25.56+/-3.78 and 14.22+/-0.67 in death group, while 16.46+/-4.09 and 12.25+/-2.33 in living group (P less than 0.05). Though POSSUM scoring system over-predicted the overall risk of death, its estimate was very close in the high risk groups (larger than 10% ). There was perfect consistence between the observed and the predicted morbidity as calculated by published predictor equation for morbidity, and consistence for mortality in the high risk band. CONCLUSIONS Modified POSSUM scoring system may be used to predict the morbidity in patients with hip fracture. Furthermore, POSSUM scoring system overpredicts the overall risk of death, but its estimate is close to the actual data in the high risk band (larger than 10%).
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Brosens RP, Oomen JL, Cuesta MA, Engel AF. Scoring Systems for Prediction of Outcome in Colon and Rectal Surgery. SEMINARS IN COLON AND RECTAL SURGERY 2008. [DOI: 10.1053/j.scrs.2008.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Schmelzer TM, Mostafa G, Lincourt AE, Camp SM, Kercher KW, Kuwada TS, Heniford BT. Factors affecting length of stay following colonic resection. J Surg Res 2007; 146:195-201. [PMID: 17936792 DOI: 10.1016/j.jss.2007.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 08/14/2007] [Accepted: 08/15/2007] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In-hospital length of stay (LOS) has become a valuable measure of outcomes following any operation, which also directly impacts cost. The aim of this study was to identify the factors that affect LOS after colonic resection. MATERIALS AND METHODS A retrospective analysis was performed of adult patients who underwent colonic resection over an 8-y period at a tertiary institution. Data collected included demographics, American Society of Anesthesiologists (ASA) score, preoperative comorbidities and medications, operative management, postoperative morbidity and mortality, and LOS. Statistical analysis included descriptive statistics and multiple logistic regression to identify variables predictive of prolonged LOS. RESULTS AND DISCUSSION A total of 899 consecutive patients were identified. One hundred eighty-seven resections were performed urgently, and 712 were elective. Two-hundred forty-five cases were performed laparoscopically. Complications occurred in 205 cases (23%), and there were 32 deaths (4%). The median LOS was 7 d. Logistic analysis showed 15 variables to be predictive of prolonged LOS. These included advanced age, warfarin sodium use, ASA score >or=3, alcoholism, chronic obstructive pulmonary disease, end-stage renal disease, illicit drug use, total colectomy (versus segmental), open resections (versus laparoscopic), and postoperative complications. In addition, the presence of at least one postoperative complication was predictive of prolonged LOS (P = 0.0002, OR 2.4 95% CI 1.5-3.8). CONCLUSIONS ASA score and the incidence of postoperative complications are the only significant categories of variables that predict prolonged LOS after colectomy. Laparoscopic approach and the extent of the resection are predictive as well.
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Affiliation(s)
- Thomas M Schmelzer
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
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Alves A, Panis Y, Mantion G, Slim K, Kwiatkowski F, Vicaut E. The AFC score: validation of a 4-item predicting score of postoperative mortality after colorectal resection for cancer or diverticulitis: results of a prospective multicenter study in 1049 patients. Ann Surg 2007; 246:91-6. [PMID: 17592296 PMCID: PMC1899212 DOI: 10.1097/sla.0b013e3180602ff5] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of the present prospective study was to validate externally a 4-item predictive score of mortality after colorectal surgery (the AFC score) by testing its generalizability on a new population. SUMMARY BACKGROUND DATA We have recently reported, in a French prospective multicenter study, that age older than 70 years, neurologic comorbidity, underweight (body weight loss >10% in <6 months), and emergency surgery significantly increased postoperative mortality after resection for cancer or diverticulitis. PATIENTS AND METHODS From June to September 2004, 1049 consecutive patients (548 men and 499 women) with a mean age of 67 +/- 14 years, undergoing open or laparoscopic colorectal resection, were prospectively included. The AFC score was validated in this population. We assessed also the predictive value of other scores, such as the "Glasgow" score and the ASA score. To express and compare the predictive value of the different scores, a receiver operating characteristic curve was calculated. RESULTS Postoperative mortality rate was 4.6%. Variables already identified as predictors of mortality and used in the AFC score were also found to be associated with a high odds ratio in this study: emergency surgery, body weight loss >10%, neurologic comorbidity, and age older than 70 years in a multivariate logistic model. The validity of the AFC score in this population was found very high based both on the Hosmer-Lemeshow goodness of fit test (P = 0.37) and on the area under the ROC curve (0.89). We also found that discriminatory capacity was higher than other currently used risk scoring systems such as the Glasgow or ASA score. CONCLUSION The present prospective study validated the AFC score as a pertinent predictive score of postoperative mortality after colorectal surgery. Because it is based on only 4 risk factors, the AFC score can be used in daily practice.
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Affiliation(s)
- Arnaud Alves
- Department of Colorectal Surgery, Hôpital Beaujon (Assistance Publique-Hôpitaux de Paris) Clichy, France
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Oomen JLT, Cuesta MA, Engel AF. Comparison of outcome of POSSUM, p-POSSUM, and cr-POSSUM scoring after elective resection of the sigmoid colon for carcinoma or complicated diverticular disease. Scand J Gastroenterol 2007; 42:841-7. [PMID: 17558908 DOI: 10.1080/00365520601113810] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare POSSUM, p-POSSUM, and cr-POSSUM-predicted mortalities with the observed postoperative mortality in patients undergoing elective sigmoid colectomy for diverticular disease (n=121) or carcinoma (n=120). MATERIAL AND METHODS The physiologic and operative severity score for the enumeration of mortality and morbidity (POSSUM) was used to identify patient- or disease-related risk factors and to calculate expected mortalities. RESULTS Patients with carcinoma had significantly higher POSSUM scores, but the observed mortality (1.7%) was lower than that in the diverticular disease group (3.3%). In the carcinoma group, mortality was over-predicted by all the POSSUM systems. In diverticular disease, POSSUM over-predicted mortality while p-POSSUM and cr-POSSUM under-predicted mortality. In the whole group, POSSUM over-predicted mortality. P-POSSUM and cr-POSSUM predicted mortality accurately: observed:expected (O:E) ratio 0.83. Replacing the score for malignancy with a minimum score of 1 gave overall O:E ratios of 0.37 (POSSUM), 1.04 (p-POSSUM), and 0.93 (cr-POSSUM). CONCLUSIONS In a group of patients who underwent elective resection of the sigmoid colon for carcinoma or diverticular disease, postoperative mortality was predicted accurately by p-Possum and cr-POSSUM, especially when used without a score for malignancy. None of the POSSUM scores were predictive of disease-specific mortality.
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Affiliation(s)
- Joannes L T Oomen
- Department of Surgery, Zaans Medical Centre, Zaandam, The Netherlands.
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Lai F, Kwan TL, Yuen WC, Wai A, Siu YC, Shung E. Evaluation of various POSSUM models for predicting mortality in patients undergoing elective oesophagectomy for carcinoma. Br J Surg 2007; 94:1172-8. [PMID: 17520711 DOI: 10.1002/bjs.5793] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background
The aim of the study was to validate the use of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM), Portsmouth (P) POSSUM and upper gastrointestinal (O) POSSUM models in patients undergoing elective thoracic oesophagectomy for carcinoma.
Methods
The observed in-hospital mortality rates in 545 patients undergoing elective thoracic oesophagectomy for squamous cell carcinoma of the oesophagus in all public hospitals in Hong Kong was compared with rates predicted by POSSUM, P-POSSUM and O-POSSUM. The discriminatory power of these models was assessed using receiver–operator characteristic (ROC) curve analysis.
Results
The observed mortality rate was 5·5 per cent, whereas rates predicted by POSSUM, P-POSSUM and O-POSSUM were 15·0, 4·7 and 10·9 per cent respectively. P-POSSUM showed no lack of fit (P = 0·814), but POSSUM (P < 0·001) and O-POSSUM (P = 0·002) showed lack of fit against observed mortality. POSSUM overpredicted mortality across nearly all risk groups, whereas O-POSSUM overpredicted mortality in patients with low physiological scores and in older patients. POSSUM (area under ROC curve 0·776) and P-POSSUM (0·776) showed equally good discriminatory power but O-POSSUM (0·676) was inferior.
Conclusion
P-POSSUM provided the most accurate prediction of in-hospital mortality in this group of patients who had elective oesophagectomy.
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Affiliation(s)
- F Lai
- Statistics and Research Unit, Head Office, Hong Kong, China
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Campillo-Soto A, Flores-Pastor B, Soria-Aledo V, Candel-Arenas M, Andrés-García B, Martín-Lorenzo JG, Aguayo-Albasini JL. Sistema POSSUM. Un instrumento de medida de la calidad en el paciente quirúrgico. Cir Esp 2006; 80:395-9. [PMID: 17192224 DOI: 10.1016/s0009-739x(06)70993-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The POSSUM scale (Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) is a scoring system that is used to predict risk-adjusted mortality and morbidity rates in a wide variety of surgical procedures. In this prospective study, the validity of the POSSUM scale was evaluated in patients undergoing laparotomy in a general surgery department. PATIENTS AND METHODS The POSSUM scale was prospectively applied in all patients undergoing elective and emergency laparotomy in the general surgery department of a level II hospital over 8 months. A total of 105 patients were included, of which 24 underwent emergency laparotomy and 81 underwent elective surgery. Predicted mortality and morbidity rates were calculated by using the POSSUM scale. These results were compared with actual outcomes by using Fisher's test. RESULTS The mean physiological score was 23.4 points (range: 12-40 points), while the mean surgical score was 11.3 points (range: 6-24 points). Three patients died during the postoperative period and 47 had morbidity. When the observed results for mortality were compared with those predicted by the POSSUM scoring system, no significant differences were observed in the analysis by risk groups, except in the risk group < 20 %, in which the POSSUM scale overestimated mortality. The risk of morbidity was underestimated by the POSSUM scale in the risk group < 20 %. CONCLUSION The POSSUM scoring system is a useful predictor of morbidity and mortality in patients undergoing emergency and elective laparotomy.
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Affiliation(s)
- Alvaro Campillo-Soto
- Servicio de Cirugía General y Digestiva. Hospital General Universitario J.M. Morales Meseguer. Murcia. España.
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Constantinides VA, Tekkis PP, Senapati A. Comparison of POSSUM scoring systems and the surgical risk scale in patients undergoing surgery for complicated diverticular disease. Dis Colon Rectum 2006; 49:1322-31. [PMID: 16680607 DOI: 10.1007/s10350-006-0522-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to evaluate the accuracy of the Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity, Portsmouth-Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity, colorectal-Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity, and the Surgical Risk Scale for the treatment of patients with complicated diverticular disease. METHODS Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity variables were prospectively recorded for 324 patients undergoing colorectal resections in 42 hospitals in the United Kingdom from January to December 2003. The accuracy of each model was evaluated by measures of discrimination, calibration, and subgroup analysis. RESULTS The overall operative mortality was 10.8 percent (Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity-estimated mortality rate, 21.9 percent; Portsmouth-Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity-estimated mortality rate, 10.5 percent; colorectal-Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity-estimated mortality rate, 10 percent; Surgical Risk Scale-estimated mortality rate, 38.2 percent). Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity and the Surgical Risk Scale over-predicted mortality in young patients (P < 0.001) and Portsmouth-Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity underpredicted mortality in elderly patients (P < 0.001). Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity and the Surgical Risk Scale overpredicted mortality in patients with generalized peritonitis (Hinchey III and IV). There was no significant difference between the observed and colorectal-Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity predicted mortality across patient subgroups and when the overall sample was considered. CONCLUSIONS The study suggested a lack of calibration of Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity, Portsmouth-Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity, and the Surgical Risk Scale at the extreme of age and for patients with severe peritoneal contamination. Colorectal-Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity was found to accurately evaluate mortality arising from complicated diverticular disease.
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Affiliation(s)
- Vasilis A Constantinides
- Department of Surgical Oncology and Technology, Imperial College London, St. Mary's Hospital, Praed Street, London W2 1NY, U.K
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Brosens RP, Oomen JL, Glas AS, van Bochove A, Cuesta MA, Engel AF. POSSUM predicts decreased overall survival in curative resection for colorectal cancer. Dis Colon Rectum 2006; 49:825-32. [PMID: 16550320 DOI: 10.1007/s10350-005-0284-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Poor condition at operation determined by the physiologic POSSUM score is related to postoperative mortality and morbidity of colorectal cancer surgery. This study was designed to analyze the relationship between condition of patients with colorectal cancer at operation and long-term overall survival. METHODS A total of 542 patients survived a radical resection for Stages I, II, or III colorectal cancer. Physiologic POSSUM score at surgery, exclusive of age, was calculated for all patients. Mean physiologic POSSUM score was used as cutoff point to determine low-risk and high-risk group patients. A Cox proportional hazard analysis was performed to study the effect of low-risk and high-risk group on overall survival and to identify independent risk factors. RESULTS Five-year overall survival was significantly higher in low-risk group patients than in high-risk group patients (low-risk group 66.6 percent vs. high-risk group 48.5 percent; P < 0.001). Differences in overall survival also were found when patients in Stages I, II, and III were analyzed separately. Risk factors for overall survival were advanced stage of disease, poor tumor differentiation, mucinous adenocarcinoma, older than age 70 years, and poor condition of the patient at time of operation. CONCLUSIONS Poor condition at operation, as determined by physiologic POSSUM score, is a risk indicator for long-term overall survival in colorectal cancer patients.
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Affiliation(s)
- Rebecca P Brosens
- Department of Surgery, Zaans Medical Centre, Zaandam, The Netherlands.
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Slim K, Panis Y, Alves A, Kwiatkowski F, Mathieu P, Mantion G. Predicting postoperative mortality in patients undergoing colorectal surgery. World J Surg 2006; 30:100-6. [PMID: 16369701 DOI: 10.1007/s00268-005-0081-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Well-known and suitable instruments for surgical audit are the POSSUM and P-POSSUM scoring systems. But these scores have not been well validated across the countries. The objective of the present study was to assess the predictive value of scores for colorectal surgery in France. Patients operated on for colorectal malignant or diverticular diseases, whether electively or on emergency basis, within a 4-month period were included in a prospective multicenter study conducted by the French Association for Surgery (Association Française de Chirurgie, AFC). The main outcome measure was postoperative in-hospital mortality. Independent factors leading to death were assessed by multivariate logistic regression analysis (AFC-index). The ratio of expected versus observed deaths was calculated, and the predictive value of the POSSUM and P-POSSUM scores were analyzed by the receiver operating characteristic (ROC) curve. A total of 1426 patients were included. The in-hospital death rate was 3.4%. Four independent preoperative factors (AFC-index) have been found: emergency surgery, loss of more than 10% of weight, neurological disease history, and age > 70 years. POSSUM had a poor predictive value; it overestimated postoperative death in all cases. P-POSSUM had a good predictive value, except for elective surgery, where it overestimated postoperative death twofold. The predictive value of the AFC-index was also good. It had the same sensitivity and specificity as the P-POSSUM. POSSUM has not been validated in France in the field of colorectal surgery. P-POSSUM was as predictive as the AFC-index which is a simpler instrument based on four clinical parameters (without any mathematical formulas).
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Affiliation(s)
- Karem Slim
- Department of Digestive Surgery, Hôtel-Dieu, Clermont-Ferrand, Boulevard Leon Malfreyt, Clermont-Ferrand Cedex 1, F-63058, France.
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Oomen JLT, Engel AF, Cuesta MA. Mortality after acute surgery for complications of diverticular disease of the sigmoid colon is almost exclusively due to patient related factors. Colorectal Dis 2006; 8:112-9. [PMID: 16412070 DOI: 10.1111/j.1463-1318.2005.00848.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Auditing the outcome of surgery for complicated diverticulitis of the sigmoid colon is difficult. A comparison of studies is hardly possible because risk factors both in terms of the severity of diverticulitis and patient-related risk factors are neither well described nor standardized. The purpose of this study was to define morbidity and mortality of primary surgery for acute complications of diverticular disease of the sigmoid colon and to identify the relation between risk factors and morbidity and mortality. METHODS In a prospective computerized morbidity and mortality registration from 1990 to 2002, 114 patients, who underwent surgery on an acute or urgent base for acute complications of diverticular disease of the sigmoid colon, were identified. In all patients the POSSUM score was calculated. To audit mortality rates a POSSUM based scoring system was introduced. RESULTS Mortality was 16.7%, and morbidity 71.1%. Higher morbidity rates were significantly related to a higher POSSUM physiological score (P = 0.012) and to older age (P < 0.001). Higher mortality rates also were significantly related to a higher POSSUM physiological score (P < 0.001) and older age (P = 0.003). Patients who died had significantly more sepsis (P < 0.001), multiple organ failure (P = 0.027), cardiac (P < 0.001) and pulmonary (P = 0.013) complications. Gender, operation indication and type of neither surgery nor surgeon had a significant relation with morbidity or mortality. CONCLUSION Surgery for acute complications of diverticular disease of the sigmoid colon carries a high morbidity rate and a substantial mortality rate. The majority of deceased patients had severe comorbidity. Post-operative mortality and morbidity are to a large extent driven by patient related factors. Elevated physiological severity scores and a lack of peri-operative management failures express this in the majority of deceased patients.
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Affiliation(s)
- J L T Oomen
- Departments of Surgery, Zaans Medical Centre, Zaandam, The Netherlands.
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Law WL, Lam CM, Lee YM. Evaluation of outcome of laparoscopic colorectal resection with POSSUM, Portsmouth POSSUM and colorectal POSSUM. Br J Surg 2006; 93:94-9. [PMID: 16288451 DOI: 10.1002/bjs.5183] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study evaluated the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM), Portsmouth (P) POSSUM and colorectal (CR) POSSUM in laparoscopic colorectal resection. METHODS Observed mortality and morbidity rates in 400 patients who underwent laparoscopic colorectal resection were compared with those predicted by POSSUM, P-POSSUM and CR-POSSUM. RESULTS Observed mortality and morbidity rates were 0.5 and 19.0 per cent respectively. Mortality rates predicted by POSSUM, P-POSSUM and CR-POSSUM were 10.8, 4.0 and 5.6 per cent respectively, and the morbidity rate predicted by POSSUM was 43.0 per cent. The predicted and observed mortality and morbidity rates showed significant lack of fit. The conversion rate to open surgery was 11.5 per cent. The mortality rate for patients having conversion was 2 per cent and was not significantly different to that predicted by P-POSSUM (4 per cent; P = 0.493) or CR-POSSUM (5 per cent; P = 0.370). In this group, the observed and POSSUM-predicted morbidity rates were also similar (43 versus 48 per cent respectively; P = 0.104). CONCLUSION POSSUM, P-POSSUM and CR-POSSUM overestimated mortality and morbidity in patients who underwent laparoscopic colorectal resection. However, the mortality rate in patients who required conversion fitted the models of P-POSSUM and CR-POSSUM, and the morbidity rate was comparable to that predicted by POSSUM.
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Affiliation(s)
- W L Law
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam Road, Hong Kong.
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Engel AF, Oomen JLT, Knol DL, Cuesta MA. Operative mortality after colorectal resection in the Netherlands. Br J Surg 2005; 92:1526-32. [PMID: 16273529 DOI: 10.1002/bjs.5153] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
The aim of this study was to quantify factors related to operative mortality after colorectal resection in the Netherlands.
Methods
Multilevel logistic regression modelling was used. Institutional effects were calculated with and without adjustment for specific patient (age, sex, urgency of operation) and hospital (number of procedures, type of hospital) characteristics. All adult Dutch patients who underwent primary colorectal resection between 1994 and 1999 were included, except those who had (sub)total colectomy or local rectal resection.
Results
A total of 67 594 patients underwent colorectal resection. The in-hospital mortality rate was 7·0 per cent (elective 3·9 per cent, acute 14·3 per cent). Acute operation (odds ratio 3·89) and age (odds ratios 2·63, 5·23 and 10·13 for patients aged 50–69, 70–79 and 80 or more years respectively compared with those aged less than 50 years) had the strongest effects, followed by male sex (odds ratio 1·48) and type of hospital. There was no difference in operative mortality rate between low-, medium- and high-volume hospitals.
Conclusion
In the Netherlands, advanced age and acute operation are by far the most important factors related to operative mortality after colorectal resection. Male sex and type of hospital have only a modest effect, and there is no discernible effect of hospital volume.
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Affiliation(s)
- A F Engel
- Department of Surgery, Zaans Medical Centre, PO Box 210, 1500 EE Zaandam, The Netherlands.
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Brooks MJ, Sutton R, Sarin S. Comparison of Surgical Risk Score, POSSUM and p-POSSUM in higher-risk surgical patients. Br J Surg 2005; 92:1288-92. [PMID: 15981213 DOI: 10.1002/bjs.5058] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Much current interest is focused on the use of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and the Portsmouth predictor equation (p-POSSUM) for risk-adjusted surgical audit. The Surgical Risk Score (SRS) has been shown to offer an equivalent accuracy, but was validated using a cohort that contained a high proportion of low-risk patients. The aim of this study was to compare the accuracy of mortality prediction using SRS with that of POSSUM and p-POSSUM in a cohort of higher-risk patients. METHODS Some 949 consecutive patients undergoing inpatient surgical procedures in a district general hospital under the care of a single surgeon were analysed. RESULTS The observed 30-day mortality rate was 8.4 per cent. Mean mortality rates predicted using SRS, POSSUM and p-POSSUM scores were 5.9, 12.6 and 7.3 per cent respectively. No significant difference was observed in the area under the receiver-operator characteristic curves for the three methods. CONCLUSION The SRS accurately predicted mortality in higher-risk surgical patients. The accuracy of prediction equalled that of POSSUM and p-POSSUM.
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Affiliation(s)
- M J Brooks
- Department of Surgery, Watford General Hospital, Watford, UK
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