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Grandi A, Bertoglio L, Lepidi S, Kölbel T, Mani K, Budtz-Lilly J, DeMartino R, Scali S, Hanna L, Troisi N, Calvagna C, D’Oria M. Risk Prediction Models for Peri-Operative Mortality in Patients Undergoing Major Vascular Surgery with Particular Focus on Ruptured Abdominal Aortic Aneurysms: A Scoping Review. J Clin Med 2023; 12:5505. [PMID: 37685573 PMCID: PMC10488165 DOI: 10.3390/jcm12175505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE The present scoping review aims to describe and analyze available clinical data on the most commonly reported risk prediction indices in vascular surgery for perioperative mortality, with a particular focus on ruptured abdominal aortic aneurysm (rAAA). MATERIALS AND METHODS A scoping review following the PRISMA Protocols Extension for Scoping Reviews was performed. Available full-text studies published in English in PubMed, Cochrane and EMBASE databases (last queried, 30 March 2023) were systematically reviewed and analyzed. The Population, Intervention, Comparison, Outcome (PICO) framework used to construct the search strings was the following: in patients with aortic pathologies, in particular rAAA (population), undergoing open or endovascular surgery (intervention), what different risk prediction models exist (comparison), and how well do they predict post-operative mortality (outcomes)? RESULTS The literature search and screening of all relevant abstracts revealed a total of 56 studies in the final qualitative synthesis. The main findings of the scoping review, grouped by the risk score that was investigated in the original studies, were synthetized without performing any formal meta-analysis. A total of nine risk scores for major vascular surgery or elective AAA, and 10 scores focusing on rAAA, were identified. Whilst there were several validation studies suggesting that most risk scores performed adequately in the setting of rAAA, none reached 100% accuracy. The Glasgow aneurysm score, ERAS and Vancouver score risk scores were more frequently included in validation studies and were more often used in secondary studies. Unfortunately, the published literature presents a heterogenicity of results in the validation studies comparing the different risk scores. To date, no risk score has been endorsed by any of the vascular surgery societies. CONCLUSIONS The use of risk scores in any complex surgery can have multiple advantages, especially when dealing with emergent cases, since they can inform perioperative decision making, patient and family discussions, and post hoc case-mix adjustments. Although a variety of different rAAA risk prediction tools have been published to date, none are superior to others based on this review. The heterogeneity of the variables used in the different scores impairs comparative analysis which represents a major limitation to understanding which risk score may be the "best" in contemporary practice. Future developments in artificial intelligence may further assist surgical decision making in predicting post-operative adverse events.
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Affiliation(s)
- Alessandro Grandi
- Department of Vascular Medicine, University Heart and Vascular Center, 20251 Hamburg, Germany
| | - Luca Bertoglio
- Division of Vascular Surgery, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, 34129 Trieste, Italy
| | - Tilo Kölbel
- Department of Vascular Medicine, University Heart and Vascular Center, 20251 Hamburg, Germany
| | - Kevin Mani
- Section of Vascular Surgery, Department of Surgical Sciences, University of Uppsala, 751 05 Uppsala, Sweden
| | - Jacob Budtz-Lilly
- Division of Vascular Surgery, Department of Cardiovascular Surgery, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Randall DeMartino
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Salvatore Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL 32610, USA
| | - Lydia Hanna
- Department of Surgery and Cancer, Imperial College London, London SW7 5NH, UK
| | - Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Cristiano Calvagna
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, 34129 Trieste, Italy
| | - Mario D’Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, 34129 Trieste, Italy
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Micheel A, Konietschke F, Hinterseher I, Kapahnke S, Bürger M, Raude B, Schawe L, Omran S, Greiner A, Frese JP. Perioperative risk prediction using the POSSUM and V-POSSUM models in symptomatic carotid stenosis. VASA 2022; 51:150-157. [DOI: 10.1024/0301-1526/a000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary: Background: This study aimed to evaluate risk factors for adverse outcomes and perioperative stroke and death in patients with symptomatic carotid stenosis undergoing open endarterectomy (CEA). The second objective was to assess the predictive value of the POSSUM and V-POSSUM models for predicting morbidity and mortality from CEA in symptomatic carotid stenosis. Patients and methods: A retrospective observational study of all patients admitted to a single center who underwent CEA for symptomatic carotid stenosis was performed. 320 patients from 1999 to 2013 were included. Postoperative complications, 30-day survival, and stroke rates were recorded. The observed outcomes were compared to the POSSUM and V-POSSUM expected mortality (observed to expected ratio (O:E)). Results: The mean age was 68.1±10.0 years. 215 patients were male (67%). Risk factors for surgical complications were: age, with a higher risk in both groups of less than 60 years and more than 75 years of age (p=0.04), a higher ASA score (p=0.04), and hyperlipidemia (p=0.017). Risk factors for the combined endpoint stroke or death were a higher ASA category (p<0.001), stroke as indication for CEA (p 0.022), and a high degree of stenosis (p=0.019). For POSSUM predicted mortality, there was a good O:E ratio in the two lowest risk groups, but a 2-fold overprediction of death or stroke in the two high-risk strata. The area under the curve (AUC) was 0.58 (95% CI: 0.43–0.73). The V-POSSUM showed a better fit in the high-risk groups, but an underprediction of mortality in the low-risk strata. Conclusions: Age and comorbid conditions are risk factors for adverse outcomes after CEA. The V-POSSUM model is better than POSSUM to predict postoperative death and stroke after CEA in patients with symptomatic carotid stenosis and a high preoperative physiological score. In patients with low physiological scores, both POSSUM and V-POSSUM show a limited predictive value.
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Affiliation(s)
- Anita Micheel
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Berlin, Germany
- Department of Internal Medicine, Bundeswehr-Zentralkrankenhaus, Koblenz, Germany
| | - Frank Konietschke
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Biometrics and Clinical Epidemiology, Berlin, Germany
| | - Irene Hinterseher
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Berlin, Germany
- Department of Vascular Surgery, Medizinische Hochschule Brandenburg Theodor-Fontane – Campus Neuruppin, Neuruppin, Germany
| | - Sebastian Kapahnke
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Berlin, Germany
| | - Matthias Bürger
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Berlin, Germany
| | - Ben Raude
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Berlin, Germany
| | - Larissa Schawe
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Berlin, Germany
| | - Safwan Omran
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Berlin, Germany
| | - Andreas Greiner
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Berlin, Germany
| | - Jan Paul Frese
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Berlin, Germany
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Chinnappa-Quinn L, Lam BCP, Harvey L, Kochan NA, Bennett M, Crawford JD, Makkar SR, Brodaty H, Sachdev PS. Surgical Hospitalization Is Not Associated With Cognitive Trajectory Over 6 Years in Healthy Older Australians. J Am Med Dir Assoc 2022; 23:608-615. [PMID: 35304131 DOI: 10.1016/j.jamda.2022.01.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim was to investigate the association of cognitive trajectories and overnight surgical hospitalization in older adults, while controlling for and comparing with the association with acute medical hospitalizations. DESIGN This is a secondary analysis of data from a population-based, longitudinal cohort study of older Australians. SETTING AND PARTICIPANTS Cognition was assessed with 4 biennial waves of prospective neuropsychological data from 1026 Sydney Memory and Aging Study participants age 70 to 90 years at baseline. Hospitalization exposure was obtained from 10 years of electronically linked data from the New South Wales Admitted Patient Data Collection. METHODS Latent growth curve modeling estimated global cognition z score baseline and slope over 6 years, and the effects of contemporaneous surgical and medical hospitalization predictors while controlling for potential demographic and comorbidity confounders. RESULTS After controlling for confounding variables, this analysis showed that overnight surgical hospitalizations were not associated with worse baseline global cognition or accelerated cognitive decline over 6 years. This was despite this cohort having more surgeries and more complex surgeries compared with Australian data for overnight hospitalizations in over 70-year-olds. Conversely, recent medical hospitalizations were associated with accelerated cognitive decline. CONCLUSIONS AND IMPLICATIONS This analysis finds that surgery and anesthesia are unlikely to be risk factors for medium to long-term global cognitive decline in healthy older adults, while controlling for contemporaneous medical hospitalizations. These findings are contrary to prior conclusions from several surgical studies that may have been impeded by insufficient comparison groups. They are, however, consistent with recent population-based studies suggesting surgery has minimal association with cognitive decline in the medium to long-term. Future research needs to clarify the association of surgical hospitalization with the full spectrum of cognitive outcomes including subjective cognitive complaints and dementia, and importantly, how these cognitive outcomes correlate with clinically significant functional changes.
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Affiliation(s)
- Lucia Chinnappa-Quinn
- Department of Anesthesia, Eastern Health, Box Hill, Victoria, Australia; Center for Healthy Brain Aging (CHeBA), School of Psychiatry, Center for Healthy Brain Aging, University of New South Wales (UNSW), Sydney, Australia
| | - Ben C P Lam
- Center for Healthy Brain Aging (CHeBA), School of Psychiatry, Center for Healthy Brain Aging, University of New South Wales (UNSW), Sydney, Australia
| | - Lara Harvey
- Falls, Balance and Injury Research Center, Neuroscience Research Australia; School of Population Health, University of New South Wales, Australia
| | - Nicole A Kochan
- Center for Healthy Brain Aging (CHeBA), School of Psychiatry, Center for Healthy Brain Aging, University of New South Wales (UNSW), Sydney, Australia
| | - Michael Bennett
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Australia; Department of Anesthesia and Hyperbaric Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - John D Crawford
- Center for Healthy Brain Aging (CHeBA), School of Psychiatry, Center for Healthy Brain Aging, University of New South Wales (UNSW), Sydney, Australia
| | - Steve Robert Makkar
- Center for Healthy Brain Aging (CHeBA), School of Psychiatry, Center for Healthy Brain Aging, University of New South Wales (UNSW), Sydney, Australia
| | - Henry Brodaty
- Dementia Center for Research Collaboration, School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia
| | - Perminder S Sachdev
- Center for Healthy Brain Aging (CHeBA), School of Psychiatry, Center for Healthy Brain Aging, University of New South Wales (UNSW), Sydney, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia.
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Dhayat SA, Tamim ANJ, Jacob M, Ebeling G, Kerschke L, Kabar I, Senninger N. Postoperative pancreatic fistula affects recurrence-free survival of pancreatic cancer patients. PLoS One 2021; 16:e0252727. [PMID: 34086792 PMCID: PMC8177431 DOI: 10.1371/journal.pone.0252727] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/20/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Postoperative pancreatic fistula (POPF) with reported incidence rates up to 45% contributes substantially to overall morbidity. In this study, we conducted a retrospective evaluation of POPF along with its potential perioperative clinical risk factors and its effect on tumor recurrence. METHODS Clinical data on patients who had received pancreatoduodenectomy (PD), distal pancreatectomy (DP), or duodenum-preserving pancreatic head resection (DPPHR) were prospectively collected between 2007 and 2016. A Picrosirius red staining score was developed to enable morphological classification of the resection margin of the pancreatic stump. The primary end point was the development of major complications. The secondary end points were overall and recurrence-free survival. RESULTS 340 patients underwent pancreatic resection including 222 (65.3%) PD, 87 (25.6%) DP, and 31 (9.1%) DPPHR. Postoperative major complications were observed in 74 patients (21.8%). In multivariable logistic regression analysis, POPF correlated with body mass index (BMI) (p = 0.025), prolonged stay in hospital (p<0.001), high Picrosirius red staining score (p = 0.049), and elevated postoperative levels of amylase or lipase in drain fluid (p≤0.001). Multivariable Cox regression analysis identified UICC stage (p<0.001), tumor differentiation (p<0.001), depth of invasion (p = 0.001), nodal invasion (p = 0.001), and the incidence of POPF grades B and C (p = 0.006) as independent prognostic markers of recurrence-free survival. CONCLUSION Besides the known clinicopathological risk factors BMI and amylase in the drain fluid, the incidence of POPF correlates with high Picrosirius red staining score in the resection margins of the pancreatic stumps of curatively resected pancreatic ductal adenocarcinoma (PDAC). Furthermore, clinically relevant POPF seems to be a prognostic factor for tumor recurrence in PDAC.
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Affiliation(s)
- Sameer A. Dhayat
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
- * E-mail:
| | - Ahmad N. J. Tamim
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Marius Jacob
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Georg Ebeling
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Iyad Kabar
- Department of Internal Medicine B, Gastroenterology and Hepatology, University Hospital Muenster, Muenster, Germany
| | - Norbert Senninger
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
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Lewis ET, Harrison R, Nicholson M, Hillman K, Trankle S, Rangel S, Stokes C, Cardona M. Clinicians' and public acceptability of universal risk-of-death screening for older people in routine clinical practice in Australia: cross-sectional surveys. Aging Clin Exp Res 2021; 33:1063-1070. [PMID: 32458357 DOI: 10.1007/s40520-020-01598-w] [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: 01/29/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Clinicians' delays to identify risk of death and communicate it to patients nearing the end of life contribute to health-related harm in health services worldwide. This study sought to ascertain doctors, nurses and senior members of the public's perceptions of the routine use of a screening tool to predict risk of death for older people. METHODS Cross-sectional online, face-to-face and postal survey of 360 clinicians and 497 members of the public. RESULTS Most (65.9%) of the members of the public welcomed (and 12.3% were indifferent to) the use of a screening tool as a decision guide to minimise overtreatment and errors from clinician assumptions. Supporters of the use of a prognostic tool were likely to be males with high social capital, chronically ill and who did not have an advance health directive. The majority of clinicians (75.6%) reported they were likely or very likely to use the tool, or might consider using it if convinced of its accuracy. A minority (13.3%) stated they preferred to rely on their clinical judgement and would be unlikely to use it. Differentials in support for tools by seniority were observed, with more support expressed by nurses, interns and registrars than medical specialists (χ2 = 12.95, p = 0.044) and by younger (< 40 years) clinicians (81.2% vs. 71.2%, p = 0.0058). DISCUSSION The concept of integrating prognostication of death in routine practice was not resisted by either target group. CONCLUSION Findings indicate that screening for risk of death is seen as potentially useful and suggests the readiness for a culture change. Future research on implementation strategies could be a step in the right direction.
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Nugent E, O'Connell E, Ooi E, McCawley N, Burke JP, McNamara DA. Impact of service delivery factors on patient outcomes in emergency general surgery. Surgeon 2020; 19:156-161. [PMID: 32444339 DOI: 10.1016/j.surge.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Emergency general surgery (EGS) is a high-risk process and is associated with poor outcomes and high mortality. This study aimed to evaluate the service delivery factors in a tertiary referral centre which may influence patient outcomes in emergency general surgery. METHODS Data on consecutive patients undergoing emergency laparotomy in a tertiary referral centre were prospectively collected from July 2017-July 2018. An extensive review of patient charts and IT systems was performed to extract demographic, clinical and care pathway data. Transfers for surgery from within the institution or within the centralised hospital network were recorded. RESULTS The unadjusted 30-day mortality rate in 163 patients undergoing emergency laparotomy was 13%. On multivariate analysis, 30-day mortality was significantly associated with p-POSSUM predicted mortality (p = 0.003), p-POSSUM predicted morbidity (p = 0.01), SORT mortality (p = 0.004), ICU admission (p = 0.02), ASA grade (p < 0.001) and transfer from non-surgical services (p < 0.001). 19.2% of patients were transferred from a referring hospital for emergency laparotomy. There was no association between inter-hospital transfer and 30-day mortality while increased mortality was observed in patients admitted to non-surgical services who required laparotomy (p < 0.001). CONCLUSION Inter-hospital transfer for emergency laparotomy was not associated with increased mortality. Increased mortality was observed in patients admitted to non-surgical services who subsequently required emergency laparotomy. Configuration of emergency general surgery services must accommodate safe and effective transfer of patients, both between and within hospitals.
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Affiliation(s)
- Emmeline Nugent
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - Emer O'Connell
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.
| | - Emma Ooi
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - Niamh McCawley
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - John P Burke
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland; Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Deborah A McNamara
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland; Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Kim SY, Kim JH, Chin H, Jun KH. Prediction of postoperative mortality and morbidity in octogenarians with gastric cancer - Comparison of P-POSSUM, O-POSSUM, and E-POSSUM: A retrospective single-center cohort study. Int J Surg 2020; 77:64-68. [PMID: 32198101 DOI: 10.1016/j.ijsu.2020.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/24/2020] [Accepted: 03/15/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate various POSSUM scoring systems in predicting postoperative morbidity and mortality in elderly patients with gastric cancer. METHODS A total of 1262 patients with gastric cancer who underwent curative gastrectomy between January 2006 and December 2013 were retrospectively reviewed. The subjects were stratified by age into <80 years old and ≥80 years old. To assess the predictability and efficacy of various POSSUM scores (POSSUM, P-POSSUM, O-POSSUM, and E-POSSUM), the observed-to-expected (O:E) ratio and area under the receiver operating characteristic curve (AUC) were calculated and compared with actual postoperative morbidity and mortality. RESULTS Among the 1262 patients, 75 were elderly (≥80 years old). The observed mortality rates were 0.5% (n = 6) in the whole cohort, and 4.0% (n = 3) in elderly patients. The predicted mortalities of POSSUM, P-POSSUM, E-POSSUM, and O-POSSUM for elderly patients were 13.2%, 5.3%, 5.7%, and 21.8%, respectively (O:E ratio = 0.3, 0.75, 0.7, and 0.18, respectively). P-POSSUM and E-POSSUM showed superior discriminatory power compared to POSSUM and O-POSSUM. In terms of morbidity, E-POSSUM showed better predictive capabilities than POSSUM in elderly patients (O:E ratio = 0.56 and 0.74, respectively). CONCLUSIONS All POSSUM scoring systems tend to overestimate postoperative mortality and morbidity in gastric cancer patients. E-POSSUM and P-POSSUM provided a better prediction of mortality and morbidity after curative gastrectomy in elderly patients compared to other POSSUM scores.
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Affiliation(s)
- Shinn Young Kim
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji-Hyun Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyungmin Chin
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyong-Hwa Jun
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Kunz JV, Spies CD, Bichmann A, Sieg M, Mueller A. Postoperative anaemia might be a risk factor for postoperative delirium and prolonged hospital stay: A secondary analysis of a prospective cohort study. PLoS One 2020; 15:e0229325. [PMID: 32084207 PMCID: PMC7034819 DOI: 10.1371/journal.pone.0229325] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/25/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Postoperative anaemia is a frequent surgical complication and in contrast to preoperative anaemia has not been validated in relation to mortality, morbidity and its associated health economic effect. Postoperative anaemia can predispose postoperative delirium through impairment of cerebral oxygenation. The aim of this secondary analysis is to investigate the association of postoperative anaemia in accordance with the sex specific World Health Organization definition of anaemia to postoperative delirium and its impact on the duration of hospital stay. METHODS A secondary analysis of the prospective multicentric observational CESARO-study was conducted. 800 adult patients undergoing elective surgery were enrolled from various operative disciplines across seven hospitals ranging from university hospitals, district general hospitals to specialist clinics of minimally invasive surgery in Germany. Patients were classified as anaemic according to the World Health Organization parameters, setting the haemoglobin level cut off below 12g/dl for females and below 13g/dl for males. Focus of the investigation were patients with acute anaemia. Patients with present preoperative anaemia or missing haemoglobin measurement were excluded from the sample set. Delirium screening was established postoperatively for at least 24 hours and up to three days, applying the validated Nursing Delirium Screening Scale. RESULTS The initial sample set contained 800 patients of which 183 were suitable for analysis in the study. Ninety out of 183 (49.2%) suffered from postoperative anaemia. Ten out of 93 (10.9%) patients without postoperative anaemia developed a postoperative delirium. In the group with postoperative anaemia, 28 (38.4%) out of 90 patients suffered from postoperative delirium (odds ratio 3.949, 95% confidence interval, (1.358-11.480)) after adjustment for NYHA-stadium, severity of surgery, cutting/suture time, duration of anaesthesia, transfusion of packed red cells and sedation status with Richmond Agitation Scale after surgery. Additionally, patients who suffered from postoperative anaemia showed a significantly longer duration of hospitalisation (7.75 vs. 12.42 days, odds ratio = 1.186, 95% confidence interval, 1.083-1.299, after adjustments). CONCLUSION The study results reveal that postoperative anaemia is not only a frequent postsurgical complication with an incidence probability of almost 50%, but could also be associated with a postoperative delirium and a prolonged hospitalisation.
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Affiliation(s)
- Julius Valentin Kunz
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité Campus Mitte and Campus Virchow Klinikum, Charité–Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Nephrology and Medical Intensive Care, Charité–Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia D. Spies
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité Campus Mitte and Campus Virchow Klinikum, Charité–Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anna Bichmann
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité Campus Mitte and Campus Virchow Klinikum, Charité–Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Miriam Sieg
- Institute of Biometry and Clinical Epidemiology, Charité–Universitaetsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Anika Mueller
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité Campus Mitte and Campus Virchow Klinikum, Charité–Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Connolly C, Stättner S, Niederwieser T, Primavesi F. Systematic review on peri-operative lactate measurements to predict outcomes in patients undergoing liver resection. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:359-370. [PMID: 32065510 PMCID: PMC7496457 DOI: 10.1002/jhbp.727] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/04/2020] [Accepted: 02/09/2020] [Indexed: 12/26/2022]
Abstract
Lactate measurements have proven utility as a triage tool, therapeutic guide, and prognostic indicator, with broad use in Acute Care and transplantation. Its value in guiding therapy and predicting outcomes following liver resection is less well‐defined. This systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines assessed the relationship between peri‐operative lactate levels and morbidity and mortality after liver resection. Seven relevant studies comprising 2573 patients in total were identified. Six studies assessed intra‐operative or early postoperative lactate levels, one publication examined pre‐operative levels. All studies demonstrated a significant association between peri‐operative lactate levels and adverse outcomes. The influence of pre‐operative diabetes and cirrhosis on postoperative lactate levels was shown in one study each, no study assessed the association of lactate with post‐hepatectomy liver failure according to defined criteria. The heterogeneity of study measurements and end‐points precluded a meta‐analysis from being performed. Early postoperative lactate >3‐3.7 mmol/L is associated with mortality but validation of clear cut‐off levels for outcome prediction is pending. Literature suggests lactate is a useful predictive marker for outcomes post liver surgery, especially when measured in the early postoperative phase. Further research is required to standardize the use of lactate measurements in a meaningful therapeutic manner.
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Affiliation(s)
- Catherine Connolly
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Stättner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Niederwieser
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Primavesi
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Kazimierczak S, Rybicka A, Strauss J, Schram M, Kazimierczak A, Grochans E. External Validation Of The Surgical Mortality Probability Model (S-MPM) In Patients Undergoing Non-Cardiac Surgery. Ther Clin Risk Manag 2019; 15:1173-1182. [PMID: 31632044 PMCID: PMC6781942 DOI: 10.2147/tcrm.s212308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/29/2019] [Indexed: 12/03/2022] Open
Abstract
Background Preoperative risk assessment is a key issue in the process of patient preparation for surgery and the control of quality improvement in health care and certification programs. Hence, there is a need for a prognostic tool, whose usefulness can be assessed only after validation in the center other than the home one. The aim of the study was to validate the Surgical Mortality Probability Model (S-MPM) for detecting deaths and complications in patients undergoing non-cardiac surgery and to assess its suitability for various surgical disciplines. Methods This retrospective study involved 38,555 adult patients undergoing non-cardiac surgery in a single center in 2012–2015. The observation period concerned in-hospital mortality. Results In-hospital mortality for the total population was 0.89%. Mortality in the S-MPM I class amounted to 0.26%, S-MPM II 2.51%, and in the S-MPM III class 22.14%. This result was in line with those obtained by the authors. The discriminatory power for in-hospital mortality was good (area under curve (AUC) = 0.852, 95% CI: 0.834–0.869, p = 0.0000). The scale was the most accurate in general surgery (AUC = 0.89, 95% CI: 0.858–0.922) and trauma (AUC = 0.89; 95% CI: 0.87–0.915). In the logistic regression analysis, the scale showed a perfect fit/goodness of fit in the cross-validation method (v-fold cross-validation): Hosmer–Lemeshow (HL) = 7.945; p = 0.159. This result was confirmed by the traditional derivation and validation data set method (1:3; 9712 vs 22.748 cases): HL test = 3.073 (p = 0.546) in the teaching derivation data set and 10.77 (p = 0.029) in the test sample (validation data set). Conclusion The S-MPM scale by Glance et al has proven to be a useful tool to assess the risk of in-hospital death and can be taken into account when considering treatment indications, patient information, planning post-operative care, and quality control.
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Affiliation(s)
- Sebastian Kazimierczak
- Anesthesiology, Perioperative Care and Pain Therapy Department, HELIOS Hospital, Berlin-Buch, Germany
| | - Anita Rybicka
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University, Szczecin, Poland
| | - Jochen Strauss
- Anesthesiology, Perioperative Care and Pain Therapy Department, HELIOS Hospital, Berlin-Buch, Germany
| | - Malgorzata Schram
- Department of Anesthesiology and Intensive Care Medicine, Evangelisch-Freikirchliches Krankenhaus Bernau, Bernau Bei Berlin, Germany
| | | | - Elżbieta Grochans
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University, Szczecin, Poland
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Nag DS, Dembla A, Mahanty PR, Kant S, Chatterjee A, Samaddar DP, Chugh P. Comparative analysis of APACHE-II and P-POSSUM scoring systems in predicting postoperative mortality in patients undergoing emergency laparotomy. World J Clin Cases 2019; 7:2227-2237. [PMID: 31531317 PMCID: PMC6718800 DOI: 10.12998/wjcc.v7.i16.2227] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/28/2019] [Accepted: 07/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Laparotomy remains one of the commonest emergency surgical procedures. Early prognostic evaluation would aid in selecting the high-risk patients for an aggressive treatment. Awareness about risks could potentially contribute to the quality of perioperative care and optimum utilization of resources. Portsmouth modification of Physiological and operative severity for the enumeration of mortality and morbidity (P-POSSUM) and the acute physiology and chronic health evaluation II (APACHE-II) have been the most widely used scoring systems for emergency laparotomies. It is always better to have a single scoring system to predict outcomes and audit healthcare organizations.
AIM To compare the ability of APACHE-II and P-POSSUM to predict postoperative morbidity and mortality in patients undergoing emergency laparotomy.
METHODS All patients undergoing emergency laparotomy at the Tata Main Hospital, Jamshedpur between December 2013 and November 2014 were included in the study. In this observational study, P-POSSUM and APACHE-II scoring were done, and the outcome analysis evaluated with mortality being the primary outcome.
RESULTS For P-POSSUM, at a cut off value of 63 to predict mortality using receiver operating characteristics curve analysis, the area under the curve was 0.989; and for APACHE-II, at the cut off value of 24, the area under the curve was 0.965.
CONCLUSION Because the ability of APACHE-II to predict mortality was similar to P-POSSUM and APACHE-II does not need scoring for intra-operative findings and histopathology reports, APACHE-II can be used pre-operatively to assess the risk in patients undergoing emergency laparotomy. However, for audit purposes, either of the two scoring systems can be used.
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Affiliation(s)
- Deb Sanjay Nag
- Department of Anaesthesiology and Critical Care, Tata Main Hospital, Jamshedpur 831001, India
| | - Ankur Dembla
- Department of Anaesthesiology and Critical Care, Darya Ram Hospital, Sonipat 131001, India
| | - Pratap Rudra Mahanty
- Department of Anaesthesiology and Critical Care, Tata Main Hospital, Jamshedpur 831001, India
| | - Shashi Kant
- Department of Anaesthesiology and Critical Care, Tata Main Hospital, Jamshedpur 831001, India
| | - Abhishek Chatterjee
- Department of Anaesthesiology and Critical Care, Tata Main Hospital, Jamshedpur 831001, India
| | - Devi Prasad Samaddar
- Department of Anaesthesiology and Critical Care, Tata Main Hospital, Jamshedpur 831001, India
| | - Parul Chugh
- Department of Biomedical Statistics, Sir Ganga Ram Hospital, New Delhi 110060, India
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Elgendy MA, Esmat IM, Kassim DY. Outcome of intraoperative goal-directed therapy using Vigileo/FloTrac in high-risk patients scheduled for major abdominal surgeries: A prospective randomized trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2017.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Mohammed A. Elgendy
- Anesthesia and Intensive Care Medicine, Ain Shams University Hospitals, Cairo, Egypt
| | - Ibrahim M. Esmat
- Anesthesia and Intensive Care Medicine, Ain Shams University Hospitals, 29-Ahmed Fuad St., Saint Fatima Square, Heliopolis, Cairo, 11361, Egypt
| | - Dina Y. Kassim
- Anesthesia and Intensive Care Medicine, BeniSweif University Hospitals, El Rehab City, Group 71, Building 15, New Cairo, 11841, Egypt
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Faisal M, Scally A, Howes R, Beatson K, Richardson D, Mohammed MA. A comparison of logistic regression models with alternative machine learning methods to predict the risk of in-hospital mortality in emergency medical admissions via external validation. Health Informatics J 2018; 26:34-44. [PMID: 30488755 DOI: 10.1177/1460458218813600] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We compare the performance of logistic regression with several alternative machine learning methods to estimate the risk of death for patients following an emergency admission to hospital based on the patients' first blood test results and physiological measurements using an external validation approach. We trained and tested each model using data from one hospital (n = 24,696) and compared the performance of these models in data from another hospital (n = 13,477). We used two performance measures - the calibration slope and area under the receiver operating characteristic curve. The logistic model performed reasonably well - calibration slope: 0.90, area under the receiver operating characteristic curve: 0.847 compared to the other machine learning methods. Given the complexity of choosing tuning parameters of these methods, the performance of logistic regression with transformations for in-hospital mortality prediction was competitive with the best performing alternative machine learning methods with no evidence of overfitting.
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Affiliation(s)
| | - Andy Scally
- University of Bradford and Bradford Institute for Health Research, UK
| | - Robin Howes
- Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, UK
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Hildén M, Wretenberg P, Ekström W. Good overall morbidity prediction with the POSSUM scoring system in patients having a total hip or knee replacement - a prospective study in 227 patients. Clin Interv Aging 2018; 13:1747-1754. [PMID: 30271129 PMCID: PMC6145357 DOI: 10.2147/cia.s165698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose The Physiological and Operation Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and P (Portsmouth)-POSSUM predict the risks of complications and mortality 30 days after surgery. The purpose of this study was to evaluate the POSSUM and P-POSSUM scoring systems in patients who underwent surgery for a total hip or knee replacement. Patients and methods A total of 227 patients with an elective primary total hip or knee replacement were included. The predicted postoperative morbidity was analyzed in these patients and compared with the observed value 30 days after surgery. Logistic regression analysis was used to assess the correlation of variables and outcome. Results The number of patients undergoing total hip or knee replacement was equally distributed with a mean age of 66.4±12.5 years; 57% of patients were females. Postoperative complications occurred in 49 patients, and POSSUM predicted 49 cases with an observed-over-expected ratio of 1.0. The average total POSSUM score was 27.4±4.4 in patients with complications and 26.8±3.5 in patients without complications (P=0.340). Wound infection (n=18), urinary tract infection (n=7), and pulmonary embolus (n=5) were the most common complications. The operation magnitude variable had the highest mean POSSUM score making it the most relevant variable. Age and blood loss and echocardiogram had the largest variance among the assessed variables. Conclusion POSSUM accurately predicted morbidities in patients undergoing elective primary total hip or knee replacement. The risk for wound infection, urinary retention, and pulmonary embolus should be considered during hospitalization. The computerized POSSUM system provides case-mix-adjusted morbidity predictions for groups and, hence, serves as a useful tool for surgical audits and large-scale benchmarking.
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Affiliation(s)
- Mattias Hildén
- Karolinska Institutet, Department of Molecular Medicine and Surgery, Karolinska University Hospital Solna, Stockholm, Sweden,
| | - Per Wretenberg
- Karolinska Institutet, Department of Molecular Medicine and Surgery, Karolinska University Hospital Solna, Stockholm, Sweden,
| | - Wilhelmina Ekström
- Karolinska Institutet, Department of Molecular Medicine and Surgery, Karolinska University Hospital Solna, Stockholm, Sweden,
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Teixeira IM, Teles AR, Castro JM, Azevedo LF, Mourão JB. Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) System for Outcome Prediction in Elderly Patients Undergoing Major Vascular Surgery. J Cardiothorac Vasc Anesth 2018; 32:960-967. [DOI: 10.1053/j.jvca.2017.08.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Indexed: 11/11/2022]
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Marmelo F, Rocha V, Moreira-Gonçalves D. The impact of prehabilitation on post-surgical complications in patients undergoing non-urgent cardiovascular surgical intervention: Systematic review and meta-analysis. Eur J Prev Cardiol 2018; 25:404-417. [DOI: 10.1177/2047487317752373] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Cardiac surgery is an aggressive procedure, inducing a great level of stress and disturbance to the homeostasis of the organism and underlying several postoperative complications. Surgical prehabilitation comprises pre-operative physical conditioning designed to improve the physiological and functional capacities of the individual, prepare the organism for surgical stress and reduce the risk of postoperative morbidity. Aim This systematic review and meta-analysis is aimed at evaluating the ability of prehabilitation to prevent post-surgical complications in cardiac patients. Methods We selected studies conducted among patients who were waiting for non-urgent cardiac surgical procedures, where a comparison between prehabilitation and standard treatment was made. A total of 3650 possible studies were researched, of which eight were selected for inclusion. Results A reduction in the number of complications in the groups submitted to prehabilitation (odds ratio = 0.41; 95% confidence interval (CI): 0.28–0.62; p < 0.001; I2 = 0%) was observed, as well as a significant increase in maximal inspiratory pressure (standard mean difference (SMD) = 0.66; 95% CI: 0.35–0.96; p < 0.001; I2 = 58%), a non-significant decrease in the length of stay (SMD = –0.56; 95% CI: −1.13, 0.01; p = 0.05; I2 = 93%), a non-significant increase in the distance walked by the intervention group in the six-minute walk test (SMD = 0.89; 95% CI −0.06, 1.84; p = 0.07) and a lack of effect on mechanical ventilation time (SMD = −0.03; 95% CI: −0.22, 0.16; p = 0.75; I2 = 0%). Conclusion Prehabilitation reduces the number of post-surgical complications and increases maximal inspiratory pressure; a reduction in the length of stay and an improvement of functional capacities are also probable.
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Affiliation(s)
- Filipe Marmelo
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, Portugal
| | - Vânia Rocha
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, Portugal
- São Martinho Hospital, Valongo, Portugal
| | - Daniel Moreira-Gonçalves
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, Portugal
- CIAFEL, Faculdade de Desporto, Universidade do Porto, Portugal
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Eslami MH, Rybin DV, Doros G, Siracuse JJ, Farber A. External validation of Vascular Study Group of New England risk predictive model of mortality after elective abdominal aorta aneurysm repair in the Vascular Quality Initiative and comparison against established models. J Vasc Surg 2018; 67:143-150. [DOI: 10.1016/j.jvs.2017.05.087] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/01/2017] [Indexed: 10/19/2022]
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19
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Makino Y, Ishida K, Kishi K, Kodama H, Miyawaki T. The association between surgical complications and the POSSUM score in head and neck reconstruction: a retrospective single-center study. J Plast Surg Hand Surg 2017; 52:153-157. [DOI: 10.1080/2000656x.2017.1372288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Yohjiroh Makino
- Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Katsuhiro Ishida
- Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Keita Kishi
- Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroki Kodama
- Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takeshi Miyawaki
- Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Aziz O, Albeyati A, Derias M, Varsani N, Ashrafian H, Athanasiou T, Clark SK, Jenkins JT, Kennedy RH. Anastomotic leaks can be detected within 5 days following ileorectal anastomosis: a case-controlled study in patients with familial adenomatous polyposis. Colorectal Dis 2017; 19:251-259. [PMID: 27444690 DOI: 10.1111/codi.13467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 06/01/2016] [Indexed: 12/18/2022]
Abstract
AIM To determine the earliest time point at which anastomotic leaks can be detected in patients undergoing total colectomy with primary ileorectal anastomosis for familial adenomatous polyposis. METHOD This was a case-controlled study of 10 anastomotic leak patients vs 20 controls following laparoscopic total colectomy with ileorectal anastomosis for familial adenomatous polyposis (from 96 consecutive patients between 2006 and 2013). Panel time-series data regression was performed using a double subscript structure to include both variables. A generalized least squares multivariate approach was applied in a random effects setting to calculate correlations for observations, with anastomotic leak being the dependent variable. Univariate and multivariate regression calculations were then performed according to individual observations at each recorded time point. Time-series analysis was used to determine when a variable became significant in the leak group. RESULTS Multivariate analysis identified a significant difference between leak and control groups in mean heart rate (P < 0.001), mean respiratory rate (P = 0.017) and mean urine output (P = 0.001). Time-point analysis showed that heart rate was significantly different between leak and control groups at postoperative day 4.25. Multivariate analysis identified a significant difference between groups in alanine transaminase (P = 0.006), bilirubin (P = 0.008), creatinine (P = 0.001), haemoglobin (P < 0.001) and urea (P = 0.007). There were no differences between groups with regard to markers of inflammation such as albumin, white blood cell count, neutrophil count and C-reactive protein. CONCLUSION Anastomotic leaks can be detected early (within 4.5 days of surgery) through changes in physiological, blood test and observational parameters, providing an opportunity for early intervention in these patients to salvage the anastomosis.
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Affiliation(s)
- O Aziz
- Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK.,The Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK
| | - A Albeyati
- Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK
| | - M Derias
- Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK
| | - N Varsani
- Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK
| | - H Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - T Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - S K Clark
- Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - J T Jenkins
- Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - R H Kennedy
- Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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Tyagi A, Nagpal N, Sidhu DS, Singh A, Tyagi A. Portsmouth physiological and operative severity score for the Enumeration of Mortality and morbidity scoring system in general surgical practice and identifying risk factors for poor outcome. J Nat Sci Biol Med 2017; 8:22-25. [PMID: 28250670 PMCID: PMC5320818 DOI: 10.4103/0976-9668.198342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Estimation of the outcome is paramount in disease stratification and subsequent management in severely ill surgical patients. Risk scoring helps us quantify the prospects of adverse outcome in a patient. Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) the world over has proved itself as a worthy scoring system and the present study was done to evaluate the feasibility of P-POSSUM as a risk scoring system as a tool in efficacious prediction of mortality and morbidity in our demographic profile. Materials and Methods: Validity of P-POSSUM was assessed prospectively in fifty major general surgeries performed at our hospital from May 2011 to October 2012. Data were collected to obtain P-POSSUM score, and statistical analysis was performed. Results: Majority (72%) of patients was male and mean age was 40.24 ± 18.6 years. Seventy-eight percentage procedures were emergency laparotomies commonly performed for perforation peritonitis. Mean physiological score was 17.56 ± 7.6, and operative score was 17.76 ± 4.5 (total score = 35.3 ± 10.4). The ratio of observed to expected mortality rate was 0.86 and morbidity rate was 0.78. Discussion: P-POSSUM accurately predicted both mortality and morbidity in patients who underwent major surgical procedures in our setup. Thus, it helped us in identifying patients who required preferential attention and aggressive management. Widespread application of this tool can result in better distribution of care among high-risk surgical patients.
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Affiliation(s)
- Ashish Tyagi
- Department of Surgery, Saraswathi Institute of Medical Sciences, Hapur, Uttar Pradesh, India
| | - Nitin Nagpal
- Department of Surgery, GGS Medical College, Faridkot, Punjab, India
| | - D S Sidhu
- Department of Surgery, GGS Medical College, Faridkot, Punjab, India
| | - Amandeep Singh
- Department of Surgery, GGS Medical College, Faridkot, Punjab, India
| | - Anjali Tyagi
- Department of ENT, Saraswathi Institute of Medical Sciences, Hapur, Uttar Pradesh, India
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Eslami MH, Rybin DV, Doros G, Farber A. Description of a risk predictive model of 30-day postoperative mortality after elective abdominal aortic aneurysm repair. J Vasc Surg 2017; 65:65-74.e2. [DOI: 10.1016/j.jvs.2016.07.103] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 07/01/2016] [Indexed: 12/11/2022]
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Hope K, Nickols G, Mouton R. Modern Anesthetic Management of Ruptured Abdominal Aortic Aneurysms. J Cardiothorac Vasc Anesth 2016; 30:1676-1684. [DOI: 10.1053/j.jvca.2016.03.147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Indexed: 01/16/2023]
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McRae PJ, Walker PJ, Peel NM, Hobson D, Parsonson F, Donovan P, Reade MC, Marquart L, Mudge AM. Frailty and Geriatric Syndromes in Vascular Surgical Ward Patients. Ann Vasc Surg 2016; 35:9-18. [PMID: 27238988 DOI: 10.1016/j.avsg.2016.01.033] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/22/2015] [Accepted: 01/04/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Preoperative frailty is an important predictor of poor outcomes but the relationship between frailty and geriatric syndromes is less clear. The aims of this study were to describe the prevalence of frailty and incidence of geriatric syndromes in a cohort of older vascular surgical ward patients, and investigate the association of frailty and other key risk factors with the occurrence of one or more geriatric syndromes (delirium, functional decline, falls, and/or pressure ulcers) and two hospital outcomes (acute length of stay and discharge destination). METHODS This prospective cohort study was conducted in a vascular surgical ward in a tertiary teaching hospital in Brisbane, Australia. Consecutive patients aged ≥65 years, admitted for ≥72 hr, were eligible for inclusion. Frailty was defined as one or more of functional dependency, cognitive impairment, or nutritional impairment at admission. Delirium was identified using the Confusion Assessment Method and a validated chart extraction tool. Functional decline from admission to discharge was identified from daily nursing documentation of activities of daily living. Falls were identified according to documentation in the medical record cross-checked with the incident reporting system. Pressure ulcers, acute length of stay, and discharge destination were identified by documentation in the medical record. Risk factors associated with geriatric syndromes, acute length of stay, and discharge destination were assessed using multivariable logistic regression models. RESULTS Of 110 participants, 43 (39%) patients were frail and geriatric syndromes occurred in 40 (36%). Functional decline occurred in 25% of participants, followed by delirium (20%), pressure ulcers (12%), and falls (4%). In multivariable logistic analysis, frailty [odds ratio (OR) 6.7, 95% confidence interval (CI) 2.0-22.1, P = 0.002], nonelective admission (OR 7.2, 95% CI 2.2-25.3, P = 0.002), higher physiological severity (OR 5.5, 95% CI 1.1-26.8, P = 0.03), and operative severity (OR 4.6, 95% CI 1.2-17.7, P = 0.03) increased the likelihood of any geriatric syndrome. Frailty was an important predictor of longer length of stay (OR 2.6, 95% CI 1.0-6.8, P = 0.06) and discharge destination (OR 4.2, 95% CI 1.2-13.8, P = 0.02). Nonelective admission significantly increased the likelihood of discharge to a higher level of care (OR 5.3, 95% CI 1.3-21.6, P = 0.02). CONCLUSIONS Frailty and geriatric syndromes were common in elderly vascular surgical ward patients. Frail patients and nonelective admissions were more likely to develop geriatric syndromes, have a longer length of stay, and be discharged to a higher level of care.
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Affiliation(s)
- Prudence J McRae
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The University of Queensland School of Medicine, Brisbane, Queensland, Australia.
| | - Philip J Walker
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The University of Queensland School of Medicine, Discipline of Surgery and Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Nancye M Peel
- The University of Queensland School of Medicine, Centre for Research in Geriatric Medicine, Brisbane, Queensland, Australia
| | - Denise Hobson
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The University of Queensland School of Medicine, Brisbane, Queensland, Australia
| | - Fiona Parsonson
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Peter Donovan
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The University of Queensland School of Medicine, Brisbane, Queensland, Australia
| | - Michael C Reade
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The University of Queensland School of Medicine, Burns, Trauma and Critical Care Research Centre, Brisbane, Queensland, Australia
| | - Louise Marquart
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Alison M Mudge
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The University of Queensland School of Medicine, Brisbane, Queensland, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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Feldheiser A, Aziz O, Baldini G, Cox BPBW, Fearon KCH, Feldman LS, Gan TJ, Kennedy RH, Ljungqvist O, Lobo DN, Miller T, Radtke FF, Ruiz Garces T, Schricker T, Scott MJ, Thacker JK, Ytrebø LM, Carli F. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand 2016; 60:289-334. [PMID: 26514824 PMCID: PMC5061107 DOI: 10.1111/aas.12651] [Citation(s) in RCA: 364] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 09/23/2015] [Accepted: 09/25/2015] [Indexed: 12/17/2022]
Abstract
Background The present interdisciplinary consensus review proposes clinical considerations and recommendations for anaesthetic practice in patients undergoing gastrointestinal surgery with an Enhanced Recovery after Surgery (ERAS) programme. Methods Studies were selected with particular attention being paid to meta‐analyses, randomized controlled trials and large prospective cohort studies. For each item of the perioperative treatment pathway, available English‐language literature was examined and reviewed. The group reached a consensus recommendation after critical appraisal of the literature. Results This consensus statement demonstrates that anaesthesiologists control several preoperative, intraoperative and postoperative ERAS elements. Further research is needed to verify the strength of these recommendations. Conclusions Based on the evidence available for each element of perioperative care pathways, the Enhanced Recovery After Surgery (ERAS ®) Society presents a comprehensive consensus review, clinical considerations and recommendations for anaesthesia care in patients undergoing gastrointestinal surgery within an ERAS programme. This unified protocol facilitates involvement of anaesthesiologists in the implementation of the ERAS programmes and allows for comparison between centres and it eventually might facilitate the design of multi‐institutional prospective and adequately powered randomized trials.
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Affiliation(s)
- A. Feldheiser
- Department of Anesthesiology and Intensive Care Medicine Campus Charité Mitte and Campus Virchow‐Klinikum Charité University Medicine Berlin Germany
| | - O. Aziz
- St. Mark's Hospital Harrow Middlesex UK
| | - G. Baldini
- Department of Anesthesia McGill University Health Centre Montreal General Hospital Montreal Quebec Canada
| | - B. P. B. W. Cox
- Department of Anesthesiology and Pain Therapy University Hospital Maastricht (azM) Maastricht The Netherlands
| | - K. C. H. Fearon
- University of Edinburgh The Royal Infirmary Clinical Surgery Edinburgh UK
| | - L. S. Feldman
- Department of Surgery McGill University Health Centre Montreal General Hospital Montreal Quebec Canada
| | - T. J. Gan
- Department of Anesthesiology Duke University Medical Center Durham North Carolina USA
| | - R. H. Kennedy
- St. Mark's Hospital/Imperial College Harrow, Middlesex/London UK
| | - O. Ljungqvist
- Department of Surgery Faculty of Medicine and Health Örebro University Örebro Sweden
| | - D. N. Lobo
- Gastrointestinal Surgery National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit Nottingham University Hospitals and University of Nottingham Queen's Medical Centre Nottingham UK
| | - T. Miller
- Department of Anesthesiology Duke University Medical Center Durham North Carolina USA
| | - F. F. Radtke
- Department of Anesthesiology and Intensive Care Medicine Campus Charité Mitte and Campus Virchow‐Klinikum Charité University Medicine Berlin Germany
| | - T. Ruiz Garces
- Anestesiologa y Reanimacin Hospital Clinico Lozano Blesa Universidad de Zaragoza Zaragoza Spain
| | - T. Schricker
- Department of Anesthesia McGill University Health Centre Royal Victoria Hospital Montreal Quebec Canada
| | - M. J. Scott
- Royal Surrey County Hospital NHS Foundation Trust University of Surrey Surrey UK
| | - J. K. Thacker
- Department of Surgery Duke University Medical Center Durham North Carolina USA
| | - L. M. Ytrebø
- Department of Anaesthesiology University Hospital of North Norway Tromso Norway
| | - F. Carli
- Department of Anesthesia McGill University Health Centre Montreal General Hospital Montreal Quebec Canada
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Reeh M, Metze J, Uzunoglu FG, Nentwich M, Ghadban T, Wellner U, Bockhorn M, Kluge S, Izbicki JR, Vashist YK. The PER (Preoperative Esophagectomy Risk) Score: A Simple Risk Score to Predict Short-Term and Long-Term Outcome in Patients with Surgically Treated Esophageal Cancer. Medicine (Baltimore) 2016; 95:e2724. [PMID: 26886613 PMCID: PMC4998613 DOI: 10.1097/md.0000000000002724] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Esophageal resection in patients with esophageal cancer (EC) is still associated with high mortality and morbidity rates. We aimed to develop a simple preoperative risk score for the prediction of short-term and long-term outcomes for patients with EC treated by esophageal resection. In total, 498 patients suffering from esophageal carcinoma, who underwent esophageal resection, were included in this retrospective cohort study. Three preoperative esophagectomy risk (PER) groups were defined based on preoperative functional evaluation of different organ systems by validated tools (revised cardiac risk index, model for end-stage liver disease score, and pulmonary function test). Clinicopathological parameters, morbidity, and mortality as well as disease-free survival (DFS) and overall survival (OS) were correlated to the PER score. The PER score significantly predicted the short-term outcome of patients with EC who underwent esophageal resection. PER 2 and PER 3 patients had at least double the risk of morbidity and mortality compared to PER 1 patients. Furthermore, a higher PER score was associated with shorter DFS (P < 0.001) and OS (P < 0.001). The PER score was identified as an independent predictor of tumor recurrence (hazard ratio [HR] 2.1; P < 0.001) and OS (HR 2.2; P < 0.001). The PER score allows preoperative objective allocation of patients with EC into different risk categories for morbidity, mortality, and long-term outcomes. Thus, multicenter studies are needed for independent validation of the PER score.
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Affiliation(s)
- Matthias Reeh
- From the Departments of General, Visceral and Thoracic Surgery (MR, JM, FGU, MN, TG, MB, JRI, YKV) and Department of Intensive Care (SK), University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg; and Departments of General, Visceral and Thoracic Surgery (UW), University Hospital Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany
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Nag DS. Assessing the risk: Scoring systems for outcome prediction in emergency laparotomies. Biomedicine (Taipei) 2015; 5:20. [PMID: 26615537 PMCID: PMC4662940 DOI: 10.7603/s40681-015-0020-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/29/2015] [Indexed: 02/05/2023] Open
Abstract
Emergency laparotomy is the commonest emergency surgical procedure in most hospitals and includes over 400 diverse surgical procedures. Despite the evolution of medicine and surgical practices, the mortality in patients needing emergency laparotomy remains abnormally high. Although surgical risk assessment first started with the ASA Physical Status score in 1941, efforts to find an ideal scoring system that accurately estimates the risk of mortality, continues till today. While many scoring systems have been developed, no single scoring system has been validated across multiple centers and geographical locations. While some scoring systems can predict the risk merely based upon preoperative findings and parameters, some rely on intra-operative assessment and histopathology reports to accurately stratify the risk of mortality. Although most scoring systems can potentially be used to compare risk-adjusted mortality across hospitals and amongst surgeons, only those which are based on preoperative findings can be used for risk prognostication and identify high-risk patients before surgery for an aggressive treatment. The recognition of the fact, that in the absence of outcome data in these patients, it would be impossible to evaluate the impact of quality improvement initiatives on risk-adjusted mortality, hospital groups and surgical societies have got together and started to pool data and analyze it. Appropriate scoring systems for emergency laparotomies would help in risk prognostication, risk-adjusted audit and assess the impact of quality improvement initiative in patient care across hospitals. Large multi-centric studies across varied geographic locations and surgical practices need to assess and validate the ideal and most apt scoring system for emergency laparotomies. While APACHE-II and P-POSSUM continue to be the most commonly used scoring system in emergency laparotomies,studies need to compare them in their ability to predict mortality and explore if either has a higher sensitivity and specificity than the other.
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Affiliation(s)
- Deb Sanjay Nag
- Department of Anaesthesiology & Critical Care, Tata Main Hospital, 831001, Jamshedpur, India.
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Eslami MH, Rybin D, Doros G, Kalish JA, Farber A. Comparison of a Vascular Study Group of New England risk prediction model with established risk prediction models of in-hospital mortality after elective abdominal aortic aneurysm repair. J Vasc Surg 2015; 62:1125-33.e2. [DOI: 10.1016/j.jvs.2015.06.051] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/01/2015] [Indexed: 12/17/2022]
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Bao DM, Li N, Xia L. Risk assessment and decision-making for patients undergoing orthopedic surgery. J Orthop Surg Res 2015; 10:169. [PMID: 26515242 PMCID: PMC4625727 DOI: 10.1186/s13018-015-0308-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/18/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Physical and operative severity score for the enumeration of mortality and morbidity (POSSUM) scoring system was designed to predict the postoperative morbidity and mortality mainly in general surgery. The purpose of this study was to assess the value of POSSUM scoring system in predicting outcomes of patients undergoing orthopedic surgery, and to do some modifications to make the system more accurate in predicting postoperative complication rates. METHODS This is a retrospective clinical study involving 779 patients between April 1, 2009 and September 1, 2010. The postoperative complication rates were predicted by POSSUM, and then compared with the actual morbidity. Logistic regression was taken to improve the POSSUM equation. RESULTS In the 779 cases, the predicted morbidity was 27.2% (212 cases) by POSSUM, while the actual morbidity is 8.3% (65 cases). CONCLUSION POSSUM excessively predicted the morbidity of patients undergoing orthopedic surgery, and it could be more accurate with appropriate modification. Of all risk factors, echocardiography ejection fraction showed a close relationship with postoperative complications.
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Affiliation(s)
- De-ming Bao
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China.
| | - Ning Li
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China.
| | - Lei Xia
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China.
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Masago T, Morizane S, Honda M, Isoyama T, Koumi T, Ono K, Kadowaki H, Sejima T, Takenaka A. Estimation of mortality and morbidity risk of radical cystectomy using POSSUM and the Portsmouth predictor equation. Cent European J Urol 2015; 68:270-6. [PMID: 26568864 PMCID: PMC4643712 DOI: 10.5173/ceju.2015.636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 05/31/2015] [Accepted: 06/22/2015] [Indexed: 11/23/2022] Open
Abstract
Introduction The Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) and the Portsmouth predictor equation (P-POSSUM) are simple scoring systems used to estimate the risk of complications and death postoperatively. We investigated the use of these scores to predict the postoperative risk in patients undergoing radical cystectomy (RC). Material and methods In this retrospective study, we enrolled 280 patients who underwent RC for invasive bladder cancer between January 2003 and December 2011. Morbidity and mortality were predicted using the POSSUM and P-POSSUM equations. We further assessed the ability of the POSSUM and P-POSSUM to predict the mortality and morbidity risk in RC patients with a Clavien–Dindo classification of surgical complications of grade II or higher. Results The observed morbidity and mortality rates were 58.9% (165 patients) and 1.8% (5 patients), respectively. Predicted morbidity using POSSUM was 49.2% (138 patients) compared to the 58.9% (165 patients) observed (P <0.0001). Compared to the observed death rate of 1.8% (5 patients), predicted mortality using POSSUM and P-POSSUM was 12.1% (34 patients) and 3.9% (11 patients), respectively (P <0.0001 and P = 0.205). The mortality risk estimated by P-POSSUM was not significantly different from the observed mortality rate. Conclusions The results of this study supported the efficacy of POSSUM combined with P-POSSUM to predict morbidity and mortality in patients undergoing RC. Further prospective studies are needed to better determine the usefulness of POSSUM and P-POSSUM for a comparative audit in urological patients undergoing RC.
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Affiliation(s)
- Toshihiko Masago
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Tadahiro Isoyama
- Division of Urology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Tsutomu Koumi
- Division of Urology, Japanese Red Cross Society Matsue Hospital, Matsue, Japan
| | - Kouji Ono
- Division of Urology, Japanese Red Cross Society Tottori Hospital, Tottori, Japan
| | | | - Takehiro Sejima
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
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Kim SH, Kil HK, Kim HJ, Koo BN. Risk Assessment of Mortality Following Intraoperative Cardiac Arrest Using POSSUM and P-POSSUM in Adults Undergoing Non-Cardiac Surgery. Yonsei Med J 2015; 56:1401-7. [PMID: 26256987 PMCID: PMC4541674 DOI: 10.3349/ymj.2015.56.5.1401] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/20/2014] [Accepted: 10/27/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) and its Portsmouth modification (P-POSSUM) are comprehensive assessment methods for evaluating patient and surgical factors widely used to predict 30-day mortality rates. In this retrospective study, we evaluated the usefulness of POSSUM and P-POSSUM in predicting 30-day mortality after intraoperative cardiac arrests in adult patients undergoing non-cardiac surgery. MATERIALS AND METHODS Among 190486 patients who underwent anesthesia, 51 experienced intraoperative cardiac arrest as defined in our study protocol. Predicted mortality rates were calculated using POSSUM and P-POSSUM equations and were compared with actual outcomes using exponential and linear analyses. In addition, a receiver operating characteristic curve analysis was undertaken, and area-under-the-curve (AUC) values with confidence intervals (CIs) were calculated for POSSUM and P-POSSUM. RESULTS Among the 51 patients with intraoperative cardiac arrest, 32 (62.7%) died within 30 days postoperatively. The overall predicted 30-day mortality rates using POSSUM and P-POSSUM were 65.5% and 57.5%, respectively. The observed-to-predicted (O:E) ratio for the POSSUM 30-day mortality was 1.07, with no significant difference between the observed and predicted values (χ²=4.794; p=0.779). P-POSSUM predicted mortality equally well, with an O:E ratio of 1.10 (χ²=8.905; p=0.350). AUC values (95% CI) were 0.771 (0.634-0.908) and 0.785 (0.651-0.918) for POSSUM and P-POSSUM, respectively. CONCLUSION Both POSSUM and P-POSSUM performed well to predict overall 30-day mortality following intraoperative cardiac arrest in adults undergoing non-cardiac surgery at a university teaching hospital in Korea.
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Affiliation(s)
- Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hae Keum Kil
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Jin Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Bon Nyeo Koo
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Abstract
Esophagectomy is a high-risk operation with significant perioperative morbidity and mortality. Attention to detail in many areas of perioperative management should lead to an aggregation of marginal gains and improvement in postoperative outcome. This review addresses preoperative assessment and patient selection, perioperative care (focusing on pulmonary prehabilitation, ventilation strategies, goal-directed fluid therapy, analgesia, and cardiovascular complications), minimally invasive surgery, and current evidence for enhanced recovery in esophagectomy.
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Affiliation(s)
- Adam Carney
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, City Campus, Hucknall Road, Nottingham NG5 1PB, UK.
| | - Matt Dickinson
- Department of Anaesthesia, Perioperative Medicine and Pain, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey GU2 7XX, UK
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Tighe D, Kwok A, Putcha V, McGurk M. Identification of appropriate outcome indices in head and neck cancer and factors influencing them. Int J Oral Maxillofac Surg 2014; 43:1047-53. [DOI: 10.1016/j.ijom.2014.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 11/26/2022]
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Williams DJ, Walker JD. A nomogram to calculate the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM). Br J Surg 2013; 101:239-45. [PMID: 24281922 DOI: 10.1002/bjs.9363] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2013] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) is a well validated model for the prediction of perioperative mortality and morbidity with application to surgery and intensive care medicine. The outcome measure calculations are time-consuming, complex and potentially error-prone. Nomograms are low-cost easy-to-use graphic devices that can be used to make repeated calculations to an acceptable level of accuracy for most clinical purposes. This paper describes a nomogram to aid calculation of POSSUM scores. METHODS This graphic solution consists of two sections: a tally sheet to calculate physiological and operative severity scores (PS and OS), and a nomogram to calculate mortality and morbidity. The latter was designed using standard mathematical methods, and drafted with the aid of commercially available software. Accuracy was confirmed by using a spreadsheet to generate 120 random sets of simulated values for PS and OS, and corresponding calculated values for predicted mortality and morbidity. The outcome values in each case were derived using the nomogram and compared with the spreadsheet values using Bland-Altman analysis. RESULTS Bland-Altman analysis showed close agreement between nomogram and spreadsheet. Bias of the nomogram was -0·1 percentage points for mortality and 0·1 percentage points for morbidity, with limits of agreement of -2·1 to +1·9 and -1·4 to +1·6 percentage points for mortality and morbidity respectively. Correlation coefficients were r > 0·999 and P < 0·001 for both mortality and morbidity. CONCLUSION The nomogram provides a rapid, accurate, low-cost means of performing, visualizing and cross-checking POSSUM calculations.
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Affiliation(s)
- D J Williams
- Department of Anaesthetics, Welsh Centre for Burns, Abertawe Bro Morgannwg University NHS Trust, Swansea, UK
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McMillan M, Brearley J. Assessment of the variation in American Society of Anesthesiologists [corrected] Physical Status Classification assignment in small animal anaesthesia. Vet Anaesth Analg 2013; 40:229-36. [PMID: 23402568 DOI: 10.1111/vaa.12007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 08/08/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the interobserver variability in the assignment of the American Society of Anesthesiologists Physical Status Classification (ASA-PSC) to compromised small animal patients amongst a group of veterinary anaesthetists. STUDY DESIGN Anonymous internet survey. ANIMALS Hypothetical case presentations. METHODS Sixteen hypothetical small animal cases with differing degrees of physiological or patho-physiological compromise were presented as part of an internet survey. Respondents were asked to assign a single ASA-PSC to each case and also to answer a number of demographic questions. ASA-PSC scores were considered separately and then grouped as scores of I-II and III-V. Agreement was analysed using the modified kappa statistic for multiple observers. Data were then sorted into various demographic groups for further analysis. RESULTS There were 144 respondents of which 60 (~42%) were anaesthesia diplomates, 24 (~17%) were post-residency (nondiploma holders), 24 (~17%) were current anaesthesia residents, 21 (~15%) were general practitioners, 12 (~8%) were veterinary nurses or technicians, and 3 (~2%) were interns. Although there was a majority agreement (>50% in a single category) in 15 of the 16 cases, ASA-PSC were spread over at least three ASA-PS classifications for every case. Overall agreement was considered only fair (κ = 0.24, mean ± SD agreement 46 ± 7%). When comparing grouped data (ASA-PSC I-II versus III-V) overall agreement remained fair (κ = 0.36, mean ± SD agreement 69 ± 19%). There was no difference in ASA-PSC assignment between any of the demographic groups investigated. CONCLUSIONS AND CLINICAL RELEVANCE This study suggests major discrepancies can occur between observers given identical information when using the ASA-PSC to categorise health status in compromised small animal patients. The significant potential for interobserver variability in classification allocation should be borne in mind when the ASA-PSC is used for clinical, scientific and statistical purposes.
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Affiliation(s)
- Matthew McMillan
- Department of Clinical Veterinary Medicine, University of Cambridge, Cambridge, UK.
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Pelavski AD, Lacasta A, de Miguel M, Rochera MI, Roca M. Mortality and surgical risk assessment among the extreme old undergoing emergency surgery. Am J Surg 2013; 205:58-63. [DOI: 10.1016/j.amjsurg.2012.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 03/05/2012] [Accepted: 03/05/2012] [Indexed: 11/27/2022]
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Park JH, Jeong SH, Kwag SJ, Park TJ, Jeong CY, Ju YT, Jung EJ, Hong SC, Choi SK, Ha WS, Lee YJ. Identification of Prognostic Factors for In-Hospital Mortality in Acute Mesenteric Ischemia. Vasc Specialist Int 2012. [DOI: 10.5758/kjves.2012.28.3.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Ji Ho Park
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Sang Ho Jeong
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Seung Jin Kwag
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Tae Jin Park
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Chi Young Jeong
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Young Tae Ju
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Eun Jung Jung
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Soon Chan Hong
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Sang Kyung Choi
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Woo Song Ha
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
| | - Young Joon Lee
- Department of Surgery, Gyeongsang National University, Post-graduate School of Medicine, Jinju, Korea
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Grant SW, Grayson AD, Mitchell DC, McCollum CN. Evaluation of five risk prediction models for elective abdominal aortic aneurysm repair using the UK National Vascular Database. Br J Surg 2012; 99:673-9. [DOI: 10.1002/bjs.8731] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2012] [Indexed: 11/09/2022]
Abstract
Abstract
Background
There is no consensus on the best risk prediction model for mortality following elective abdominal aortic aneurysm (AAA) repair. The objective was to evaluate the performance of five risk prediction models using the UK National Vascular Database (NVD).
Methods
Data on elective AAA repairs from the NVD between January 2008 and December 2010 were analysed. The models assessed were: Glasgow Aneurysm Score (GAS), Vascular Biochemical and Haematological Outcome Model (VBHOM), physiological component of the Vascular Physiological and Operative Severity Score for enUmeration of Mortality (V-POSSUM), Medicare and Vascular Governance North West (VGNW). Overall model discrimination and calibration in equally sized risk-group quintiles were assessed.
Results
The study cohort included 10 891 patients undergoing elective AAA repair (median age 74 years, 87·3 per cent men). The in-hospital mortality rates following endovascular and open repair were 1·3 and 4·7 per cent respectively (2·9 per cent overall). The Medicare and VGNW models both showed good discrimination (area under receiver operating characteristic (ROC) curve 0·71), whereas the GAS, VBHOM and V-POSSUM models showed poor discrimination (area under ROC curve 0·60, 0·61 and 0·62 respectively). The VGNW model was the only one to predict the overall mortality rate in the cohort (3·3 per cent predicted versus 2·9 per cent observed; P = 0·066). The VGNW model demonstrated good calibration, predicting risk accurately in four risk-group quintiles. The Medicare, V-POSSUM and VBHOM models accurately predicted risk in three, two and no risk-group quintiles respectively.
Conclusion
The Medicare and VGNW models contain similar risk factors and showed good discrimination when applied to the NVD. Both models would be suitable for risk prediction after elective AAA repair in the UK.
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Affiliation(s)
- S W Grant
- University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester, Academic Surgery Unit, Education and Research Centre, Manchester, UK
| | - A D Grayson
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - D C Mitchell
- Vascular Society Audit Committee, The Royal College of Surgeons of England, London, UK
| | - C N McCollum
- University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester, Academic Surgery Unit, Education and Research Centre, Manchester, UK
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Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Am J Surg 2011; 204:139-43. [PMID: 22178483 DOI: 10.1016/j.amjsurg.2011.08.012] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 07/10/2011] [Accepted: 08/04/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND The clinical syndrome of frailty identified through the assessment of weight loss, gait speed, grip strength, physical activity, and physical exhaustion has been used to identify patients with reduced reserves. We hypothesized that frailty is useful in predicting adverse outcomes in optimized elective elderly colorectal surgery patients. METHODS A prospective study was conducted at 2 centers (Singapore and Japan). All patients over 75 years of age undergoing colorectal resection were assessed for the presence of the syndrome of frailty. All these patients had already had their comorbidities optimized for surgery. The outcome measure was postoperative major complications (defined as Clavien-Dindo type II and above complications). RESULTS Eighty-three patients were studied from February 2008 to April 2010. The mean age was 81.5 years (range 75-93 years). The mean comorbidity index was 3.37 (range 0-11). Twenty-six (31.3%) patients were an American Society of Anesthesiologists (ASA) score of 3 and above. Chi-square analysis revealed that the odds ratio of postoperative major complications was 4.083 (95% confidence interval, 1.433-11.638) when the patient satisfied the criteria for frailty. Albumin <35, ASA >3, comorbidity index >5, and Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scores were not predictive of postoperative major complications. CONCLUSIONS Preliminary findings show that frailty is a potent adjunctive tool of predicting postoperative morbidity. Frailty can be used to identify elderly patients needing further optimization before major surgery.
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Kumar S, Gupta A, Chaudhary S, Agrawal N. Validation of the use of POSSUM score in enteric perforation peritonitis - results of a prospective study. Pan Afr Med J 2011; 9:22. [PMID: 22145058 PMCID: PMC3215544 DOI: 10.4314/pamj.v9i1.71197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 03/28/2011] [Indexed: 11/17/2022] Open
Abstract
Introduction The objective of the study was to present our last 5-years experience of peritonitis and validate POSSUM score in predicting mortality and morbidity in patients of enteric perforation (EP) peritonitis. Methods Data was collected prospectively for all peritonitis cases admitted in single surgical unit from January 2005 to December 2009. Parameters for calculating POSSUM were also retrieved; in these patients, O:E (Observed vs. Expected) ratio of mortality and morbidity were estimated after calculating predicted mortality and morbidity by exponential regression equations. Results 887 patients with peritonitis were admitted and treated in this unit during the 5 years of study period. Duodenal (n=431; 48%) followed by ileal (n=380; 42.8%) perforations were the commonest. Mean age of the patients was 34 years and 86% were males. Mean delay in presentation was 78.5 hrs. Mean duration of hospital and ICU stay was 13 and 7.2 days. Postoperative complications were seen in 481 (54%) patients, and 90 (10%) patients died. POSSUM scores and predicted mortality/morbidity were calculated in 380 patients of ileal perforation peritonitis; O:E ratio of mortality and morbidity were 0.47 and 0.85 in these patients. Conclusion POSSUM and P-POSSUM are accurate tools for predicting morbidity and mortality respectively in EP patients. Though they may sometime over or under predict morbidity as well as mortality.
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Affiliation(s)
- Sunil Kumar
- Department of Surgery, University College of Medical Sciences and associated Guru Teg Bahadur Hospital, New Delhi-110095, India
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Utility of a generic risk prediction score in predicting outcomes after orofacial surgery for cancer. Br J Oral Maxillofac Surg 2011; 49:281-5. [DOI: 10.1016/j.bjoms.2010.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 06/02/2010] [Indexed: 11/19/2022]
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A Collaborative Transdisciplinary “Geriatric Surgery Service” Ensures Consistent Successful Outcomes in Elderly Colorectal Surgery Patients. World J Surg 2011; 35:1608-14. [DOI: 10.1007/s00268-011-1112-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Tan KY, Konishi F, Tan L, Chin WK, Ong HY, Tan P. Optimizing the management of elderly colorectal surgery patients. Surg Today 2010; 40:999-1010. [PMID: 21046496 DOI: 10.1007/s00595-010-4354-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 04/28/2010] [Indexed: 12/20/2022]
Abstract
With the ever increasing number of geriatric surgical patients, there is a need to develop efficient processes that address all of the potential issues faced by patients during the perioperative period. This article explores the physiological changes in elderly surgical patients and the outcomes achieved after major abdominal surgery. Perioperative management strategies for elderly surgical patients in line with the practices of the Geriatric Surgical Team of Alexandra Health, Singapore, are also presented. A coordinated transdisciplinary approach best tackles the complexities encountered in these patients.
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Affiliation(s)
- Kok-Yang Tan
- Geriatric Surgery Service, Alexandra Health, Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore, Singapore
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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: 4.3] [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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Arnalich F, Maldifassi MC, Ciria E, Quesada A, Codoceo R, Herruzo R, Garcia-Cerrada C, Montoya F, Vazquez JJ, López-Collazo E, Montiel C. Association of cell-free plasma DNA with perioperative mortality in patients with suspected acute mesenteric ischemia. Clin Chim Acta 2010; 411:1269-74. [PMID: 20478285 DOI: 10.1016/j.cca.2010.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 05/05/2010] [Accepted: 05/06/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND Diagnosing patients with acute mesenteric ischemia (AMI) in the emergency ward is challenging. This study assesses the usefulness of plasma DNA in patients with clinically suspected AMI. METHODS 130 consecutive patients who underwent laparotomy were studied. Cell-free plasma DNA was measured by real-time quantitative PCR assay for the beta-globin gene. The primary endpoint was the accuracy of plasma DNA for predicting 30-day mortality. RESULTS Surgery revealed AMI in 99 patients and alternative diagnoses in 31 patients. Forty-six patients with AMI died (46.6%) as compared to 6 (19.4%) in the non-AMI group (p<0.05). The DNA concentration at admission was significantly higher in patients with AMI (median 7340 GE/ml, versus, 2735 GE/ml, p<0.01) and in AMI patients who died (8830 GE/ml, versus 4970 GE/ml, p<0.05). The area under the ROC curves for plasma DNA as a marker for mesenteric ischemia and independent predictor for 30-day mortality were 0.708 (95% CI 0.701-0.890) and 0.815 (95% CI 0.735-0.894). Multiple logistic regression analysis showed that the risk of hospital mortality increased 1.52-fold for every 1000 GE/ml increase in plasma DNA. CONCLUSIONS Plasma DNA levels may be a useful biomarker in predicting the outcome of patients with AMI.
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Affiliation(s)
- Francisco Arnalich
- Emergency Medicine Service, Internal Medicine Department, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain.
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Chen W, Fong J, Lind C, Knuckey N. P–POSSUM scoring system for mortality prediction in general neurosurgery. J Clin Neurosci 2010; 17:567-70. [DOI: 10.1016/j.jocn.2009.09.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Accepted: 09/13/2009] [Indexed: 10/19/2022]
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Zhang Y, Fu L, Zhang ZD, Li ZJ, Liu XB, Hu WM, Mai G, Yan LI, Zeng Y, Tian BL. Evaluation of POSSUM in predicting post-operative morbidity in patients undergoing pancreaticoduodenectomy. J Int Med Res 2010; 37:1859-67. [PMID: 20146884 DOI: 10.1177/147323000903700622] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) is a predictive scoring system for post-operative morbidity. The present study assessed the value of POSSUM in predicting post-operative morbidity following pancreaticoduodenectomy (PD). POSSUM scores were prospectively calculated for 265 consecutive cases of PD performed between 2005 and 2007. Expected morbidity was estimated based on POSSUM scores and was compared with observed morbidity. Patients were also stratified into one of four groups based on their individual POSSUM scores and subsequent risk of morbidity. Mean expected morbidity was 43.81% (116 cases) and mean observed morbidity was 39.62% (105 cases) (no statistically significant difference). It is concluded that the POSSUM scoring system has high value for predicting the risk of morbidity in PD patients.
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Affiliation(s)
- Y Zhang
- Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Luna A, Rebasa P, Navarro S, Montmany S, Coroleu D, Cabrol J, Colomer O. An evaluation of morbidity and mortality in oncologic gastric surgery with the application of POSSUM, P-POSSUM, and O-POSSUM. World J Surg 2009; 33:1889-94. [PMID: 19603227 DOI: 10.1007/s00268-009-0118-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Evaluation of surgical results observed in oncologic gastric surgery with reference to estimation of risks through POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity), P-POSSUM (Portsmouth POSSUM), and O-POSSUM (regression model based on the POSSUM and P-POSSUM, especially designed for gastric and esophagus surgery). METHODS A prospective follow-up of a cohort of 106 consecutive patients, gastrectomized because of gastric cancer. The variables studied were: age, sex, technical surgery, American Society of Anesthesiologists (ASA) score, the Charlson comorbidity index, morbidity, and mortality. RESULTS From January 2004 to April 2008, 131 patients were operated on for gastric neoplasia. Of these, 28 patients were excluded: 5 because of nonstandard gastrectomy, 17 because of staging laparoscopy or unresectable cancer after laparotomy, and 3 because of palliative gastroenteroanastomosis; 106 patients were included. We performed 38 total gastrectomies, 65 distal gastrectomies, 2 esophagogastrectomies, and 1 proximal gastrectomy. The mean age was 68 years (standard deviation (SD) = 12.1; range, 34-85 years). Associated comorbidity (Charlson) was 5.4 (SD = 2.7; range, 2-16); ASA 1 at 1.9%; ASA 2 at 36.8%; ASA 3 at 43.4%; and ASA 4 at 17.9%. Expected morbidity, according to POSSUM was 46.7%; observed morbidity was 50.5%. Morbidity ratio observed/expected was 1.08. Expected mortality, according to POSSUM = 13%, according to P-POSSUM = 4.9%, and according to O-POSSUM = 12.1%. Observed mortality was 7.8%. Mortality ratio observed/expected according to POSSUM, P-POSSUM, O-POSSUM was 0.6, 1.6, and 0.6, respectively. Morbidity results were within the confidence interval of the POSSUM estimation. Our results show lower mortality than the POSSUM and the O-POSSUM estimation (P < 0.001) and higher mortality regarding P-POSSUM estimation (P < 0.001). CONCLUSIONS The control systems of risk allow us continuous evaluation of our results and objective comparison to other teams. Compared with the POSSUM scoring systems, our series showed quality improvement (morbidity and mortality) over time.
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Affiliation(s)
- Alexis Luna
- Department of General Surgery, Hospital de Sabadell, Sabadell, Catalonia, Spain.
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