Performance of two prediction scores in predicting postoperative morbidities after colorectal surgery
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Abstract:
Objective
To investigate the value of two prediction scores in predicting postoperative morbidities after colorectal surgery.
Methods
Data of patients who underwent colorectal surgery between September 2017 and September 2018 were retrospectively collected and reviewed. There were 177 patients in total. Surgical Apgar Score (SAS) and colorectal physiological and operative severity score for the enumeration of mortality and morbidity(CR-POSSUM) were calculated for each patient. Patients were grouped as morbidity group and normal group. And patients were grouped as major complication group and no or minor complication group. Major complication was defined as complications grade 3 and upper according to the definition of Clavien-Dindo grading.
Results
Univariable analysis demonstrated that neither SAS nor CR-POSSUM was predictive of the occurrence of major complication. And Univariable analysis demonstrated that only SAS was predictive of the occurrence of postoperative complication (χ2=6.127, P=0.013), while CR-POSSUM was not. Receiver operation curve (ROC) demonstrated that area under the curve of intraoperative SAS in predicting the occurrence of complication after colorectal surgery was 0.605±0.043 (95% CI: 0.521~0.689, P=0.017). Sensitivity and specificity of SAS was 58.8% and 60.0% respectively in predicting the occurrence of complication when the cutoff was set as 9.
Conclusion
Intraoperative Surgical Apgar Score was predictive of the occurrence of complication after colorectal surgery with moderate discrimination. It should be in combination with other prediction tools.
Key words:
Colorectal neoplasms; Surgery; Complication; Prediction scoresKeywords:
Colorectal Surgery
Grading (engineering)
Vascular surgery
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To assess the use of Physical and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) scoring system in predicting outcomes of patients undergoing orthopedic surgery and provide guidance for operation treatment decisions.From April 2009 to September 2010, a total of 779 cases went operation in Beijing Hospital were collected.They were divided into two groups according to the presence or absence of complications.The patients' postoperative complications were predicted by POSSUM and compared to the actual morbidity to verify the effectiveness of the equation.Logistic regression was taken to make appropriate improvements for the POSSUM equation.ROC curve was drawn to describe the compliance of the original and new equations.In the 779 cases, the morbidity predicted by POSSUM is 212 cases while the actual morbidity is 65 cases.Of all risk factors, echocardiography ejection fraction showed a close relationship with postoperative complications (P<0.01). In the original equation, actual complication group compared with non-complication group, the difference was statistically significant (P<0.01). In the modified equation, complication group compared with non-complication group, the difference was statistically significant (P<0.01). Compared with the original one , the modified POSSUM had better predictive value on postoperative morbidity, and the comparison of AUC between the two groups was statistically significant ((0.67 ± 0.12) vs (0.75 ± 0.08), P<0.01).POSSUM over predicted morbidity of patients undergoing orthopedic surgery, it can be more accurate when modified appropriately.
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Clinical data of patients underwent pancreaticoduodenectomy due to malignant ampullary tumors from January 2013 and December 2016 in our hospital with full access to medical records were collected, and 144 patients were enrolled in total.Surgical Apgar Score (SAS) was calculated based on the intraoperative lowest mean arterial pressure, lowest heart rate and blood loss.The patients were divided into 2 groups depending on whether postoperative delirium developed or not within 7 days after surgery.The receiver operating characteristic curve of SAS in predicting postoperative delirium was drawn.The area under the curve, optimal cut-off value and sensitivity and specificity were calculated.Thirty-six patients developed postoperative delirium, and the incidence was 25.0%.The area under the curve of SAS in predicting postoperative delirium was 0.86 (95% confidence interval 0.79-0.91). The optimal cut-off value was 6 with a sensitivity of 86% and a specificity of 83%.In conclusion, intraoperative SAS can predict the development of postoperative delirium in patients undergoing pancreaticoduodenectomy.
Key words:
Apgar Score; delirium; postoperative complication
Apgar score
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Objective To evaluate the modified POSSUM surgical scoring system in urologic surgery patients over 70. Methods 180 patients over 70 were retrospectively analyzed with the mo dified POSSUM surgical scoring system.A comparison between the observed and the predicted morbidity was made. Results In the complication group and noncomplication group,the mean age of the patients were 74.9±4.1 and 74.7±3.6,the mean length of stay were (42.1±4.2)d and (28.7± 14.2 )d,respectively.In the complication group,both the physiological scores and the operative severity scores of POSSUM scoring system were significantly higher than the no complication group ( 22.0 ± 4.1 vs 20.1±3.9 in pysiological score and 11.7±4.3 vs 10.3±3.5 in operative severity score, P 0.05 ).There was perfect agreement between the observed and the predicted morbidity as calculated by published predictor equation for morbidity. Conclusions Modified POSSUM scoring msystem may be appropriately used to predict the occurence of complication in urologic surgery patients over 70.
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ABSTRACT Background: Although several risk scoring systems that predict postoperative complication incidence are available, the optimal scoring tool for elderly colorectal cancer patients remains unknown. Material and Methods: Records of 659 patients underwent surgery for colorectal cancer were retrospectively reviewed, and 130 patients aged >80 years were divided into two groups according to postoperative complications (Clavien-Dindo classification ≥ grade II) as Complication group and Non-complication group.Scoring systems such as the Surgical Apgar score (SAS), and the Prognostic nutritional index (PNI), and sections of the Physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM; physiological score (PS-P), and operative severity score (OS-P)), the Colorectal POSSUM (CR-POSSUM; physiological score (PS-CP) and operative severity score (OS-CP)), and Estimating the physiologic ability and surgical stress score (E-PASS; preoperative risk score (PRS), surgical stress score (SSS) and comprehensive risk score (CRS)) were analyzed. Results: The PS-P, PRS, and CRS were significantly different between the two groups in univariate analysis. Area under the Receiver Operating Characteristic Curve of PRS was the highest among the scoring systems. Multivariate analysis also showed PRS was a useful risk scoring tool. Conclusions: PRS may be useful for predicting the occurrence of complications for colorectal cancer in elderly patients. Highlights:
Colorectal Surgery
Univariate analysis
Surgical stress
Apgar score
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Background: POSSUM and P-POSSUM are risk scores recommended by ERAS Society for the preoperative evaluation of patients undergoing major surgery. Methods: This study includes 113 consecutive pancreaticoduodenectomy performed in a single centre between July 2013-December 2015. Patients data were prospectively collected using Excel 2009 and retrospectively analysed with R v3.2.4 software. Biological status score, surgical severity score and risk scores for complications and death were calculated using: http://www.riskprediction. org.uk/index-pp.php. Results: Morbidity rate was 61,95%: 19,47% general complications, 14,16% wound infections and 28,32% PD specific complications (11,5% POPF; 8,85% DGE and 6,19% PPH). Comparing the observed and estimated morbidity and mortality, we obtained statistical significant results (p=0,05 and p=0,03, respectivelly). When we considered only specific PD complications and subsequent mortality, there was no longer significant difference between observed and estimated values (p=0,8 and p=0,86).The under ROC curve aria was 0,61 for morbidity and 0,64 for specific PD morbidity, respectively 0,61 for mortality and 0,68 for specific PD complications related mortality.P-POSSUM represents a useful tool for appreciating the complication and death risk after PD, but better results could be obtain by considering also specific PD risk factors.
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Univariate analysis
Perforation
Colorectal Surgery
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Surgery remains the best curative option for oesophageal cancer. This demanding intervention performed on a high risk patient is accompanied by high morbidity and mortality rates. The aim of this study was to analyse the preoperative risk assessment using different comorbidity models inpatients operated for esophageal cancer in a tertiary unit.A retrospective study was conducted on aprospectively collected database. The performance of several prognostic scores (POSSUM, P-POSSUM, O-POSSUM, Charlson and age adjusted Charlson, ASA score) was assessed in terms of early postoperative outcomes.Out of 137 patients diagnosed with oesophageal cancer, esophagectomy was performed in 43 cases.Postoperative mortality (11.62%) was best predicted by POSSUM score (10.48; 95% CI 9.37 -11.66). The observed morbidity was 58.13%, higher than that expected by POSSUM (48.24%; 95%CI, 44.82-51.66) with a morbidity ratio O E of 1.2. The area under the ROC curve for the physiological score of POSSUM and age adjusted Charlson index showed a good discriminatory power. The best performance was obtained for POSSUM equation, who showed to have the highest area under the ROC curve (0.826; 95%CI, 0.67-0.92).A thoroughly assessment of comorbidities and the surgeon's clinical assessment remain the best tool for patient selection for surgery.
Esophagectomy
Charlson comorbidity index
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ObjectiveTo evaluate the correlation and efficacy of Preoperative Risk Evaluation System for Geriatric Orthopedic Patients (PRESGOP), Acute Physiology and Chronic Health Evaluation (APACHE) and Physiological and Operative Score for the Enumeration of Mortality and Morbidity (POSSUM)in predicting the postoperative complications and mortality in old orthopedic patients.Methods From January, 2009 to February, 2010, 401 geriatric orthopedic patients who underwent surgery in our department were enrolled in the present prospective trial. All cases were divided into 4 groups according to presence or absence of complication and death respectively. The 4 groups were evaluated by PRESGOP, APACHE and POSSUM scoring systems and then compared using T test. The 3 kinds of scores were also compared for their correlations and Receiver Operating Characteristic(ROC) curves.Results Comparisons of the complication and complication-free groups, only in PRESGOP death and death-free groups have significant differences( P ＜ O. 05). The Pearson correlative coefficient of PRESGOP and APACHE was 0. 300, while that of PRESGOP and POSSUM was O. 538. The correlative coefficient of APACHE and POSSUM was O. 490. The areas under ROC curve associated with 3 total scores accumulated and complications were O. 77 1 (PRESGOP),0. 634 (APACHE), and 0. 751 (POSSUM). And the areas under ROC curve depicted by 3 predictive mortalities were 0. 920 (PRESGOP), 0. 877 (APACHE), and 0. 836 (POSSUM).Condusions The 3 evaluation systems are correlative and valid in predicting postoperative complications and mortality in old orthopedic patients. The PRESGOP system may be more exact in predictive efficacy for Chinese old orthopaedic patients.
Key words:
Geriatric; Peroperative period; Risk; Evaluation
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For the assessment of elderly patients can tolerate lung cancer operation, there is no clear standard. To evaluate the clinical validity of POSSUM (Physiological and Operative Severity Score for the Umeration of Mortality and Morbidity) in elderly non-small cell lung cancer (NSCLC) surgery patients, we want to provide an important basis for operation treatment decisions.A total of 138 patients, with 88 males and 50 females, with elderly NSCLC surgery between December 2007 and December 2013, are included in PLA general hospital. Using the multivariate Logistic regression analysis, we evaluate the value of each factor on the actual postoperative complications mortality and morbidity. The scorings on standard POSSUM and modified POSSUM in the complication group are compared with the non-complication group using the group t test. Drawing receiver operating characteristic (ROC) curve in standard POSSUM group and modified POSSUM group, calculating the area under the curve (AUC), AUC in standard group is compared with modified group using t test. Judge if the modified POSSUM prediction is consistent with the actual mortality and morbidity.Among 138 patients, there were 77 postoperative complications in 59 patients, 2 cases of death. According to the Logistic regression analysis, 17 of 18 factors in standard POSSUM, pulmonary function, different TNM stage are predictors for postoperative complications (P<0.05). Age is a predictor for postoperative death (P<0.05). In the standard POSSUM scoring, actual complication group compared with non-complication group, the difference is statistically significant (P<0.01). In the modified POSSUM scoring, complication group is compared with non-complication group, the difference is statistically significant (P<0.01). Compared with the standard POSSUM, the modified POSSUM has better predictive value on postoperative morbidity, and the comparison of AUC between the two groups is statistically significant. But the latter shows the overpredicted mortality (P<0.01).The modified POSSUM has a good predictive value on postoperative complications in elderly NSCLC surgery patients, so it can provide the basis for decision-making operation treatment.背景与目的 对于评价老年患者能否耐受肺癌手术，目前尚无明确标准。本研究旨在探讨改良POSSUM（Physiological and Operative Severity Score for the Umeration of Mortality and Morbidity）评分在预测老年非小细胞肺癌（non-small cell lung cancer, NSCLC）患者术后并发症发生率和病死率中的应用价值，为手术治疗的决策提供重要依据。方法 2007年12月-2013年12月在解放军总医院接受手术治疗的老年NSCLC患者138例，其中男性88例，女性50例，收集临床资料，各因素对术后实际并发症发生率和病死率的影响，采用二值多元Logistic回归分析。在有、无并发症两组中，采用成组t检验对标准及改良POSSUM评分值进行比较。绘制标准POSSUM和改良POSSUM的受试者工作特征曲线（receiver operating characteristic curve, ROC），计算曲线下面积（area under the curve, AUC），两组间AUC比较采用t检验。计算改良POSSUM评分预测值和实际并发症发生率和病死率的符合度。结果 共有59例患者出现77例次术后并发症，手术死亡2例。Logistic回归分析，标准POSSUM的18项指标中17项及肺功能、肿瘤分期对术后并发症的发生有统计学意义（P<0.05），年龄对术后死亡有统计学意义（P<0.05）。在标准POSSUM评分中，并发症组与无并发症组的评分比较，差异有统计学意义（P<0.01）。在改良POSSUM评分中，并发症组与无并发症组的评分比较，差异有统计学意义（P<0.01）。改良POSSUM较标准POSSUM对术后并发症发生有更好的预测价值，两组AUC比较，差异有统计学意义（P<0.01）。但改良POSSUM对手术死亡的预测值过高。结论 改良POSSUM评分对老年NSCLC术后并发症发生有较好的预测价值，可为决策手术治疗提供依据。
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