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Shekar N, Debata PK, Debata I, Nair P, Rao LS, Shekar P. Use of POSSUM (Physiologic and Operative Severity Score for the Study of Mortality and Morbidity) and Portsmouth-POSSUM for Surgical Assessment in Patients Undergoing Emergency Abdominal Surgeries. Cureus 2023; 15:e40850. [PMID: 37489217 PMCID: PMC10363332 DOI: 10.7759/cureus.40850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION The POSSUM (Physiologic and Operative Severity Score for the Study of Mortality and Morbidity) and Portsmouth-POSSUM (P-POSSUM) models have been popularly recommended as appropriate for predicting postoperative mortality and morbidity in surgical practice. This study aims to evaluate the efficacy and accuracy of both scoring systems for surgical risk assessment in predicting postoperative mortality and morbidity in patients undergoing emergency abdominal surgeries. METHODOLOGY The study was conducted as a part of a post-doctoral fellowship program. A total of 150 patients, undergoing emergency abdominal surgery in a tertiary care hospital in Bhubaneswar, were evaluated using POSSUM and P-POSSUM. Physiological scoring was done prior to surgery and operative scoring was performed intra-operatively. Patients were followed up for 30 days after the operative period. The observed mortality rate was then compared with POSSUM and P-POSSUM predicted mortality rates. RESULTS POSSUM predicted a morbidity rate of 116, whereas the actual morbidity rate was 92 (p < 0.05). P-POSSUM predicted a morbidity rate of 109, whereas the actual morbidity rate was 92 (p < 0.05). POSSUM predicted a mortality rate of 23, whereas the actual mortality rate was 21 (p < 0.05). P-POSSUM predicted a mortality rate of 25, whereas the actual mortality rate was 21 (p < 0.05). CONCLUSIONS With a reasonably good prediction of morbidity and mortality rate, POSSUM and P-POSSUM scores are both effective scoring systems in clinical practice for use in abdominal surgery.
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Affiliation(s)
- Nithya Shekar
- General Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - P K Debata
- General Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Ipsita Debata
- Community and Family Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Pallavi Nair
- General Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Lakshmi S Rao
- General Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Prithvi Shekar
- General Surgery, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, IND
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Fugazzola P, Cobianchi L, Di Martino M, Tomasoni M, Dal Mas F, Abu-Zidan FM, Agnoletti V, Ceresoli M, Coccolini F, Di Saverio S, Dominioni T, Farè CN, Frassini S, Gambini G, Leppäniemi A, Maestri M, Martín-Pérez E, Moore EE, Musella V, Peitzman AB, de la Hoz Rodríguez Á, Sargenti B, Sartelli M, Viganò J, Anderloni A, Biffl W, Catena F, Ansaloni L. Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study. World J Emerg Surg 2023; 18:20. [PMID: 36934276 PMCID: PMC10024826 DOI: 10.1186/s13017-023-00488-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/04/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Less invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models. METHOD The S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models-POSSUM Physiological Score (PS), modified Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade-receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities. RESULTS A 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p < 0.001; 30-day mortality: AUC 0.94, p < 0.001; in-hospital major morbidity: AUC 0.73, p < 0.001; 30-day major morbidity: AUC 0.70, p < 0.001). POSSUM PS with a cutoff of 25 (defined in our study as a 'Chole-POSSUM' score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96-97% negative predictive value for major complications. CONCLUSIONS The Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate prediction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may find the most useful field of action. TRIAL REGISTRATION ClinicalTrial.gov NCT04995380.
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Affiliation(s)
- Paola Fugazzola
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Cobianchi
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy.
| | - Marcello Di Martino
- Hepato-Biliary and Liver Transplantation Department, AORN Cardarelli, Napoli, Italy
| | - Matteo Tomasoni
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Venice, Italy
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | | | - Marco Ceresoli
- General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital, University of Pisa, Pisa, Italy
| | - Salomone Di Saverio
- Department of Surgery, Madonna Del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Tommaso Dominioni
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Camilla Nikita Farè
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Frassini
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Gambini
- Unit of Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marcello Maestri
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elena Martín-Pérez
- Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Ernest E Moore
- Denver Health System - Denver Health Medical Center, Denver, USA
| | - Valeria Musella
- Unit of Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Ángela de la Hoz Rodríguez
- Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Benedetta Sargenti
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, 62100, Macerata, Italy
| | - Jacopo Viganò
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Fausto Catena
- General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
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Fugazzola P, Cobianchi L, Di Martino M, Tomasoni M, Dal Mas F, Abu-Zidan FM, Agnoletti V, Ceresoli M, Coccolini F, Di Saverio S, Dominioni T, Farè CN, Frassini S, Gambini G, Leppäniemi A, Maestri M, Martín-Pérez E, Moore EE, Musella V, Peitzman AB, de la Hoz Rodríguez Á, Sargenti B, Sartelli M, Viganò J, Anderloni A, Biffl W, Catena F, Ansaloni L, Augustin G, Morić T, Awad S, Alzahrani AM, Elbahnasawy M, Massalou D, De Simone B, Demetrashvili Z, Kimpizi AD, Schizas D, Balalis D, Tasis N, Papadoliopoulou M, Georgios P, Lasithiotakis K, Ioannidis O, Bains L, Magnoli M, Cianci P, Conversano NI, Pasculli A, Andreuccetti J, Arici E, Pignata G, Tiberio GAM, Podda M, Murru C, Veroux M, Distefano C, Centonze D, Favi F, Bova R, Convertini G, Balla A, Sasia D, Giraudo G, Gabriele A, Tartaglia N, Pavone G, D’Acapito F, Fabbri N, Ferrara F, Cimbanassi S, Ferrario L, Cioffi S, Ceresoli M, Fumagalli C, Degrate L, Degiuli M, Sofia S, Licari L, Improta M, Patriti A, Coletta D, Conti L, Malerba M, Andrea M, Calabrò M, De Zolt B, Bellio G, Giordano A, Luppi D, Corbellini C, Sampietro GM, Marafante C, Rossi S, Mingoli A, Lapolla P, Cicerchia PM, Siragusa L, Grande M, Arcudi C, Antonelli A, Vinci D, De Martino C, Armellino MF, Bisogno E, Visconti D, Santarelli M, Montanari E, Biloslavo A, Germani P, Zaghi C, Oka N, Fathi MA, Ríos-Cruz D, Hernandez EEL, Garzali IU, Duarte L, Negoi I, Litvin A, Chowdhury S, Alshahrani SM, Carbonell-Morote S, Rubio-Garcia JJ, Moreira CCL, Ponce IA, Mendoza-Moreno F, Campaña AM, Bayo HL, Serra AC, Landaluce-Olavarria A, Serradilla-Martín M, Cano-Paredero A, Dobón-Rascón MÁ, Hamid H, Baraket O, Gonullu E, Leventoglu S, Turk Y, Büyükkasap Ç, Aday U, Kara Y, Kabuli HA, Atici SD, Colak E, Chooklin S, Chuklin S, Ruta F, Estraviz-Mateos B, Markinez-Gordobil I. Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study. World J Emerg Surg 2023; 18:20. [DOI: https:/doi.org/10.1186/s13017-023-00488-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/04/2023] [Indexed: 11/27/2023] Open
Abstract
Abstract
Background
Less invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models.
Method
The S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models—POSSUM Physiological Score (PS), modified Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade—receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities.
Results
A 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p < 0.001; 30-day mortality: AUC 0.94, p < 0.001; in-hospital major morbidity: AUC 0.73, p < 0.001; 30-day major morbidity: AUC 0.70, p < 0.001). POSSUM PS with a cutoff of 25 (defined in our study as a ‘Chole-POSSUM’ score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96–97% negative predictive value for major complications.
Conclusions
The Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate prediction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may find the most useful field of action.
Trial Registration: ClinicalTrial.gov NCT04995380.
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Špička P, Chudáček J, Řezáč T, Vomáčková K, Ambrož R, Molnár J, Klos D, Vrba R. Prognostic significance of comorbidities in patients with diffuse peritonitis. Eur Surg 2022. [DOI: 10.1007/s10353-022-00780-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Summary
Background
Diffuse peritonitis is a severe disease with high mortality and morbidity rates. Therapy is fundamentally surgical. It is important to identify patients with a significantly worse prognosis and patients who may benefit from more aggressive surgical and postsurgical care such as NPWT (Narrow Pressure Wound Therapy) prior to surgery. We tried to identify a determining factor for higher morbidity and mortality rates resulting in a worse prognosis among initial data and patient comorbidities in order to focus therapy towards more aggressive surgical management.
Methods
In a group of 274 patients with diffuse peritonitis, we evaluated the type of peritonitis according to effusion, origin, surgery type, and the age, gender, and present comorbidities of the patients, and compared it with the overall mortality, morbidity rate, and duration of hospitalization.
Results
Patients without comorbidities had a significantly lower burden in both morbidity and mortality. We recorded the highest difference in mortality in patients with two or more comorbidities, with pulmonary and cardiovascular diseases, with malignancy and hypertension. Morbidity was found to be significantly exacerbated by the presence of two or more severe diseases, cardiovascular disease, malignancy, and hypertension.
Conclusion
We identified age, effusion type, and the presence of comorbidities as key factors for the prognosis of our patients—the morbidity and mortality rates were substantially increased in patients with two or more comorbidities, as well as by the presence of cardiovascular disease, malignancy, and hypertension. A more aggressive approach should be considered to improve the prognosis in these patients.
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Arutyunyan AS, Blagovestnov DA, Yartsev PA, Levitsky VD, Gulyaev AA, Kislukhina EV. [Safety and efficacy of laparoscopic approach for widespread appendicular peritonitis]. Khirurgiia (Mosk) 2022:24-32. [PMID: 35775842 DOI: 10.17116/hirurgia202207124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyze treatment outcomes in patients with acute appendicitis complicated by widespread peritonitis. MATERIAL AND METHODS The study included 165 patients acute appendicitis complicated by widespread peritonitis. Inclusion criteria: acute appendicitis complicated by widespread peritonitis MIP grade 1-2 in reactive or toxic phase (grading system by Simonyan K.S.), abdominal cavity index ≤16. Exclusion criteria: MIP grade 3, terminal phase, abdominal cavity index ≥17. RESULTS Analysis of postoperative data revealed no correlation between surgical approach and incidence of postoperative intra-abdominal abscesses and infiltrates. In the main group, intra-abdominal abscesses occurred in 4.9% of patients (n=5), infiltrates - 12.8% (n=13). In the control group, these parameters were 4.6% (n=2) and 18.2% (n=8), respectively. We have developed and introduced into clinical practice a differentiated approach to surgical treatment of widespread appendicular peritonitis based on laparoscopic data. Abdominal cavity was intraoperatively assessed. The proposed method included 5 criteria with establishment of appropriate points (min 3, max 14). In case of total score 3-8, laparoscopic approach was preferred. Overall score 9-11 required laparoscopic surgery with subsequent elective repeated laparoscopy, ≥12 scores - intraoperative conversion and open surgery. Thus, subject to the rules of surgical intervention, the number of intra-abdominal complications between laparoscopic and open methods is equalized. CONCLUSION The developed differentiated surgical strategy for patients with appendicular peritonitis is effective and reduces the incidence of wound infection, extra-abdominal complications, and hospital-stay, as well as contributes to early rehabilitation of patients.
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Affiliation(s)
- A S Arutyunyan
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - D A Blagovestnov
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - P A Yartsev
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Penza Institute for Advanced Training of Doctors, Penza, Russia
| | - V D Levitsky
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Penza Institute for Advanced Training of Doctors, Penza, Russia
| | - A A Gulyaev
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Penza Institute for Advanced Training of Doctors, Penza, Russia
| | - E V Kislukhina
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
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Lebedev NV, Popov VS, Klimov AE, Svanadze GT. [Eritonitis outcome prediction]. Khirurgiia (Mosk) 2021:92-98. [PMID: 34941215 DOI: 10.17116/hirurgia202112192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review is devoted to the most common general clinical and specific grading systems for peritonitis outcome prediction. Particular attention is paid to methodological approaches, prediction reliability, simplicity of use in clinical practice and their importance in decision-making. It is shown that none of the modern grading systems is universal and absolutely reliable. Combining several systems is quite difficult and will take additional time that is impossible for intraoperative environment. Despite various systems for peritonitis outcome prediction, none of them can completely satisfy surgeons, primarily in choice of surgical access, intervention type and option for its completion.
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Affiliation(s)
- N V Lebedev
- Peoples' Friendship University of Russia, Moscow, Russia
| | - V S Popov
- Peoples' Friendship University of Russia, Moscow, Russia
| | - A E Klimov
- Peoples' Friendship University of Russia, Moscow, Russia
| | - G T Svanadze
- Peoples' Friendship University of Russia, Moscow, Russia
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Grigorescu BL, Săplăcan I, Petrișor M, Bordea IR, Fodor R, Lazăr A. Perioperative Risk Stratification: A Need for an Improved Assessment in Surgery and Anesthesia-A Pilot Study. MEDICINA-LITHUANIA 2021; 57:medicina57101132. [PMID: 34684169 PMCID: PMC8538842 DOI: 10.3390/medicina57101132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/03/2021] [Accepted: 10/15/2021] [Indexed: 12/03/2022]
Abstract
Background and Objectives: Numerous scoring systems have been introduced into modern medicine. None of the scoring systems assessed both anesthetic and surgical risk of the patient, predict the morbidity, mortality, or the need for postoperative intensive care unit admission. The aim of this study was to compare the anesthetic and surgical scores currently used, for a better evaluation of perioperative risks, morbidity, and mortality. Material and Methods: This is a pilot, prospective, observational study. We enrolled 50 patients scheduled for elective surgery. Anesthetic and surgery risk was assessed using American Society of Anesthesiologists (ASA) scale, Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM), Acute Physiology and Chronic Health Evaluation (APACHE II), and Surgical APGAR Score (SAS) scores. The real and the estimated length of stay (LOS) were registered. Results: We obtained several statistically significant positive correlations: ASA score–P-POSSUM (p < 0.01, r = 0.465); ASA score–SAS, (p < 0.01, r = −0.446); ASA score–APACHE II, (p < 0.01 r = 0.519); predicted LOS and ASA score (p < 0.01, r = 0.676); predicted LOS and p-POSSUM (p < 0.01, r = 0.433); and predicted LOS and APACHE II (p < 0.01, r = 0.454). A significant negative correlation between predicted LOS, real LOS, ASA class, and SAS (p < 0.05) was observed. We found a statistically significant difference between the predicted and actual LOS (p < 001). Conclusions: Anesthetic, surgical, and severity scores, used together, provide clearer information about mortality, morbidity, and LOS. ASA scale, associated with surgical scores and severity scores, presents a better image of the patient’s progress in the perioperative period. In our study, APACHE II is the best predictor of mortality, followed by P-POSSUM and SAS. P-POSSUM score and ASA scale may be complementary in terms of preoperative physiological factors, providing valuable information for postoperative outcomes.
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Affiliation(s)
- Bianca-Liana Grigorescu
- Department of Pathophysiology, University of Medicine, Pharmacology, Sciences and Technology, 540142 Târgu-Mureș, Romania;
| | - Irina Săplăcan
- Department of Anesthesiology and Intensive Care, Emergency County Hospital, 540136 Târgu-Mureș, Romania
- Correspondence: (I.S.); (I.R.B.); Tel.: +40-787691256 (I.S.); +40-744919391 (I.R.B.)
| | - Marius Petrișor
- Department of Simulation Applied in Medicine, University of Medicine, Pharmacology, Sciences and Technology, 540142 Târgu-Mureș, Romania;
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, University of Medicine and Pharmacy Iuliu Hațieganu, 400012 Cluj-Napoca, Romania
- Correspondence: (I.S.); (I.R.B.); Tel.: +40-787691256 (I.S.); +40-744919391 (I.R.B.)
| | - Raluca Fodor
- Department of Anesthesiology and Intensive Care, University of Medicine, Pharmacology, Sciences and Technology, 540142 Târgu-Mureș, Romania; (R.F.); (A.L.)
| | - Alexandra Lazăr
- Department of Anesthesiology and Intensive Care, University of Medicine, Pharmacology, Sciences and Technology, 540142 Târgu-Mureș, Romania; (R.F.); (A.L.)
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Kisa NG, Kisa E, Cevik BE. Prediction of Mortality in Patients After Oncologic Gastrointestinal Surgery: Comparison of the ASA, APACHE II, and POSSUM Scoring Systems. Cureus 2021; 13:e13684. [PMID: 33833910 PMCID: PMC8019072 DOI: 10.7759/cureus.13684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Scoring systems have been developed to predict the expected mortality and morbidity in surgical procedures. In this study, our aim was to compare the ASA (American Society of Anesthesiologists), APACHE (Acute Physiology and Chronic Health Evaluation) II, POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) scoring systems as predictors of mortality in patients who underwent gastrointestinal oncologic surgery, followed, and were admitted to the intensive care unit during the postoperative period. We examined the files of 82 patients who underwent oncologic gastrointestinal surgery and followed up in the intensive care units (ICUs). The patients’ APACHE II scores and predicted mortality rates (PMR) according to the APACHE II, POSSUM, and ASA scores were calculated. The receiver operator characteristic (ROC) curve analysis was used when evaluating the performances of the ASA, APACHE, and POSSUM scoring systems in terms of accurate assessment of mortality. Accordingly, the area under the curve (AUC) = 0.5 no distinction, 0.5 <AUC <0.7 discriminative power of the test is statistically not significant, 0.7 <AUC <0.8 acceptable, 0.8 <AUC <0.9 very good and 0.9 <AUC <1 perfect. The evaluations showed that APACHE II had the best performance with 0.81, followed by POSSUM, which had an acceptable level at 0.78. On the other hand, the ASA score was 0.63 and its discriminative power was identified as statistically insignificant. Our results show that the POSSUM and APACHE II scoring systems were better at predicting mortality than the ASA scoring system for the prediction of mortality in the postoperative period. Both the POSSUM and APACHE II scoring systems can be confidently used for the prediction of mortality in patients undergoing operations due to oncologic gastrointestinal diseases.
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Affiliation(s)
- Nagihan Gozde Kisa
- Anesthesiology and Reanimation, Golcuk Necati Celik State Hospital, Kocaeli, TUR
| | - Emre Kisa
- Anesthesiology and Critical Care, Derince Education and Research Hospital, Kocaeli, TUR
| | - Banu Eler Cevik
- Anesthesiology and Reanimation, Kartal Dr. Lutfi Kirdar Research& Education Hospital, Istanbul, TUR
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Gupta B, Ahluwalia P. Knowledge, attitude, and practices of Indian anesthesiologists regarding the comprehensive preanesthetic assessment of geriatric patients: A cross-sectional survey. BALI JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.4103/bjoa.bjoa_26_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Hu ZW, Xin RQ, Xia YJ, Jia GP, Chen XX, Wang S. Application of POSSUM and P-POSSUM in Surgical Risk Assessment of Elderly Patients Undergoing Hepatobiliary and Pancreatic Surgery. Clin Interv Aging 2020; 15:1121-1128. [PMID: 32764899 PMCID: PMC7367927 DOI: 10.2147/cia.s258659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/26/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the efficacy and accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) scoring systems in the risk assessment of postoperative complications and death in elderly patients undergoing hepatobiliary and pancreatic surgery. Patients and Methods Using POSSUM and P-POSSUM, 274 elderly patients undergoing hepatobiliary and pancreatic surgery were evaluated, and the complications and deaths predicted by the systems were compared with the actual situation. The accuracy and predictive ability of POSSUM and P-POSSUM were evaluated using chi-squared and t-tests, consistency of predicted and actual complication rates (observed/expected, OE ratio), and receiver operating characteristic (ROC) curve. Results The complication rate predicted by POSSUM (R1) was 22.57%, while the actual postoperative complication rate was 17.88% (P>0.05). The mortality rate predicted by POSSUM (R2) was 4.61%, while the actual rate was 1.09% (P<0.05). The mortality rate predicted by P-POSSUM (R) was 1.42%, while the actual rate was 1.09% (P>0.05). Patients with complications had higher physiology scores (PS), operative severity scores (OS), and POSSUM scores than those without complications (P<0.05). Furthermore, PS, OS, and POSSUM scores were higher in the mortality group than in the survival group. However, the number of individuals in the mortality group was too small to accurately reflect the overall situation. Stratified analysis showed that consistency of the OE ratio in different subgroups was close to 1. The ROC curve showed that the area under the curve for the complication rate predicted by POSSUM was 0.76. Conclusion Although the postoperative mortality rate was higher than the actual value, POSSUM could accurately predict the postoperative complication rate in elderly patients undergoing hepatobiliary and pancreatic surgery. The P-POSSUM accurately predicted the postoperative mortality rate in this population. Patients with complications had higher POSSUM scores.
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Affiliation(s)
- Zhi-Wei Hu
- Department of Hepatobiliary and Pancreatic Surgery, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia Autonomous Region, People's Republic of China
| | - Rui-Qiang Xin
- Department of Hepatobiliary and Pancreatic Surgery, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia Autonomous Region, People's Republic of China
| | - Yi-Jun Xia
- Department of Hepatobiliary and Pancreatic Surgery, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia Autonomous Region, People's Republic of China
| | - Guang-Peng Jia
- Department of Hepatobiliary and Pancreatic Surgery, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia Autonomous Region, People's Republic of China
| | - Xiao-Xu Chen
- Department of Hepatobiliary and Pancreatic Surgery, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia Autonomous Region, People's Republic of China
| | - Shi Wang
- Department of Hepatobiliary and Pancreatic Surgery, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia Autonomous Region, People's Republic of China
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Kaneda H, Nakano T, Murakawa T. The predictive value of preoperative risk assessments and frailty for surgical complications in lung cancer patients. Surg Today 2020; 51:86-93. [PMID: 32588154 DOI: 10.1007/s00595-020-02058-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/14/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE To assess the predictive value of frailty and risk assessments for postoperative complications in lung cancer patients, we reviewed various risk indicators: including FEV1, ppoFEV1, the Zubrod performance status, the American Society of Anesthesiologist score, and risk models based on the Japan National Clinical Database (NCD) and the European Society of Thoracic Surgeons (ESTS) database. METHODS Patients who underwent elective surgery between April 2016 and May 2019 were enrolled. A statistical analysis was performed to compare any differences among the risk indicators. RESULTS The total number of patients enrolled was 193. Thirteen patients (6.7%) were classified as frail and 28 (14.5%) as pre-frail. Among the various risk indicators, the risk models based on the Japan NCD and the ESTS database revealed statistically significant differences in patients with and without postoperative complications (p value < 0.0001 and 0.0049, respectively), although there were no significant differences in frailty. The area under the receiver operating characteristic curve for risk models based on the Japan NCD registry and the ESTS registry was 0.70 and 0.64, respectively. CONCLUSIONS Our analyses of a series of lung cancer patients showed that frailty was not a significant predictor of postoperative outcomes, while risk models based on academic society databases were found to have a significant predictive value.
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Affiliation(s)
- Hiroyuki Kaneda
- Division of Thoracic Surgery, Kansai Medical University Medical Center, 10-15 Fumizonocho, Moriguchishi, Osaka, 570-8507, Japan.
- Department of Thoracic Surgery, Kansai Medical University, Hirakatashi, Osaka, Japan.
| | - Takahito Nakano
- Division of Thoracic Surgery, Kansai Medical University Medical Center, 10-15 Fumizonocho, Moriguchishi, Osaka, 570-8507, Japan
- Department of Thoracic Surgery, Kansai Medical University, Hirakatashi, Osaka, Japan
| | - Tomohiro Murakawa
- Department of Thoracic Surgery, Kansai Medical University, Hirakatashi, Osaka, Japan
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