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Operative Severity Score (operative + severity_score)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Risk factors of mortality in non-trauma exsanguinating patients that require damage control laparotomy

ANZ JOURNAL OF SURGERY, Issue 4 2010
Wen-bo Zhang
Abstract Background:, Since introduction of damage control (DC) approach to non-trauma setting is relatively late, the risk factors associated with this procedure remain undefined. This study was aimed at identifying factors responsible for the mortality. Methods:, Over a 5-year period (from February 2002 to February 2007), consecutive non-trauma patients who required DC laparotomy (DCL) with gauze packing for control of indomitable abdominal haemorrhage in our institute were included. Clinical, laboratorial and operative factors influencing in-hospital or 30-day mortality were analysed. Results:, A total of 26 patients underwent DCL with packing in an attempt to control severe abdominal haemorrhage. There were seven (26.9%) deaths in hospital or within 30 days of DCL. Increase in age, higher initial physiological score and operative severity score assessed by the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity scoring system, lower initial body temperature, lower initial platelet (PLT) counts, greater intra-operative blood loss, presence of perioperative multiple organ dysfunction syndrome were all associated with increased risk of mortality on univariate analysis (P < 0.05). On multivariate analysis, only decrease in PLT counts (P= 0.042, OR = 0.969, 95% CI = 0.940,0.999) and increase in age (P= 0.035, OR = 1.152, 95% CI = 1.010,1.313) were significant independent factors affecting mortality. Conclusions:, Decrease in PLT counts and increase in age are the independent risk factors related to death in non-trauma series that require DCL with packing. DCL should be performed early as for patients with these risk factors. [source]

Elderly POSSUM, a dedicated score for prediction of mortality and morbidity after major colorectal surgery in older patients

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2010
P. Tran Ba Loc
Background: Several scores have been developed to evaluate surgical unit mortality and morbidity. The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and derivatives use preoperative and intraoperative factors, whereas the Surgical Risk Scale (SRS) and Association Française de Chirurgie (AFC) score use four simple factors. To allow for advanced age in patients undergoing colorectal surgery, a dedicated score,the Elderly (E) POSSUM,has been developed and its accuracy compared with these scores. Methods: From 2002 to 2004, 1186 elderly patients, at least 65 years old, undergoing major colorectal surgery in France were enrolled. Accuracy was assessed by calculating the area under the receiver operating characteristic curve (AUC) (discrimination) and calibration. Results: The mortality and morbidity rates were 9 and 41 per cent respectively. The E-POSSUM had both a good discrimination (AUC = 0·86) and good calibration (P = 0·178) in predicting mortality and a reasonable discrimination (AUC = 0·77) and good calibration (P = 0·166) in predicting morbidity. The E-POSSUM was significantly better at predicting mortality and morbidity than the AFC score (Pc = 0·014 and Pc < 0·001 respectively). Conclusion: The E-POSSUM is a good tool for predicting mortality, and the only efficient scoring system for predicting morbidity after major colorectal surgery in the elderly. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Evaluation of various POSSUM models for predicting mortality in patients undergoing elective oesophagectomy for carcinoma

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2007
F. Lai
Background: The aim of the study was to validate the use of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM), Portsmouth (P) POSSUM and upper gastrointestinal (O) POSSUM models in patients undergoing elective thoracic oesophagectomy for carcinoma. Methods: The observed in-hospital mortality rates in 545 patients undergoing elective thoracic oesophagectomy for squamous cell carcinoma of the oesophagus in all public hospitals in Hong Kong was compared with rates predicted by POSSUM, P-POSSUM and O-POSSUM. The discriminatory power of these models was assessed using receiver,operator characteristic (ROC) curve analysis. Results: The observed mortality rate was 5·5 per cent, whereas rates predicted by POSSUM, P-POSSUM and O-POSSUM were 15·0, 4·7 and 10·9 per cent respectively. P-POSSUM showed no lack of fit (P = 0·814), but POSSUM (P < 0·001) and O-POSSUM (P = 0·002) showed lack of fit against observed mortality. POSSUM overpredicted mortality across nearly all risk groups, whereas O-POSSUM overpredicted mortality in patients with low physiological scores and in older patients. POSSUM (area under ROC curve 0·776) and P-POSSUM (0·776) showed equally good discriminatory power but O-POSSUM (0·676) was inferior. Conclusion: P-POSSUM provided the most accurate prediction of in-hospital mortality in this group of patients who had elective oesophagectomy. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Predicting postoperative morbidity by clinical assessment

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2005
P. M. Markus
Background: The aim of this study was to determine the accuracy of prediction of the surgeon's ,gut-feeling' in estimating postoperative outcome. Methods: A prospective series of 1077 consecutive patients undergoing major hepatobiliary or gastrointestinal surgery were studied. Patients having elective (n = 827) and emergency (n = 250) procedures were included. The surgeon predicted the development of postoperative complications immediately after completion of surgery on a scale from 0 to 100 per cent. These predictions were compared with the actual outcome and with predictions made using the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM). The Portsmouth predictor equation (P-POSSUM) was applied for the estimation of mortality. Results: The observed morbidity and mortality rates were 29·5 and 3·4 per cent respectively. POSSUM predicted a morbidity rate of 46·4 per cent and P-POSSUM a mortality rate of 6·9 per cent. The surgeon's gut-feeling was more accurate in the prediction of morbidity at 32·1 per cent. On the basis of gut-feeling, surgeons overpredicted morbidity in elective surgery, but underestimated the risk of complications in the emergency setting. The (P)-POSSUM scoring system overpredicted morbidity and mortality for elective and emergency operations. Conclusion: The surgeon's gut-feeling is a good predictor of postoperative outcome, especially after elective surgery. (P)-POSSUM overpredicted morbidity and mortality in this series of major gastrointestinal and hepatobiliary operations. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM),,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2004
P. P. Tekkis
Background: The aim of the study was to develop a dedicated colorectal Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (CR-POSSUM) equation for predicting operative mortality, and to compare its performance with the Portsmouth (P)-POSSUM model. Methods: Data were collected prospectively from 6883 patients undergoing colorectal surgery in 15 UK hospitals between 1993 and 2001. After excluding missing data and 93 patients who did not satisfy the inclusion criteria, 4632 patients (68·2 per cent) underwent elective surgery and 2107 had an emergency operation (31·0 per cent); 2437 operations (35·9 per cent) for malignant and 4267 (62·8 per cent) for non-malignant diseases were scored. Stepwise logistic regression analysis was used to develop an age-adjusted POSSUM model and a dedicated CR-POSSUM model. A 60 : 40 per cent split-sample validation technique was adopted for model development and testing. Observed and expected mortality rates were compared. Results: The operative mortality rate for the series was 5·7 per cent (387 of 6790 patients) (elective operations 2·8 per cent; emergency surgery 12·0 per cent). The CR-POSSUM, age-adjusted POSSUM and P-POSSUM models had similar areas under the receiver,operator characteristic curves. Model calibration was similar for CR-POSSUM and age-adjusted POSSUM models, and superior to that for the P-POSSUM model. The CR-POSSUM model offered the best overall accuracy, with an observed : expected ratio of 1·000, 0·998 and 0·911 respectively (test population). Conclusion: The CR-POSSUM model provided an accurate predictor of operative mortality. External validation is required in hospitals different from those in which the model was developed. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) (Br J Surg 2003; 90: 157,165)

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 5 2003
A. L. Tambyraja
No abstract is available for this article. [source]

Risk factors of mortality in non-trauma exsanguinating patients that require damage control laparotomy

POSSUM scoring for laparoscopic cholecystectomy in the elderly

ANZ JOURNAL OF SURGERY, Issue 7 2005
Andrew L. Tambyraja
Background: Physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) scoring is a validated scoring system in the audit of surgical outcomes; however, evaluation of this system has mostly been applied to open surgical techniques. The present study examines the validity of POSSUM in predicting morbidity and mortality in patients undergoing laparoscopic cholecystectomy (LC) with the recognized risk factor for postoperative mortality of advanced age. Methods: All patients aged 80 years or over undergoing LC in one surgical unit between January 1993 and December 1999 were identified from the surgical operations database of the hospital. Case-note review was used to collate data in terms of clinical and operative factors as described in POSSUM. Observed/POSSUM estimated (O/E) ratio of morbidity and 30-day mortality were calculated. Results: Laparoscopic cholecystectomy was performed in 76 patients aged 80 years or over during the study period. Of these patients, case notes for 70 patients (92%) were available for review. Median (range) age was 83 years (80,93 years) and median (range) American Society of Anesthesiologists score was 2 (2,4). Twenty-six (34%) of 70 patients underwent cholecystectomy during an acute admission. The mean physiology severity score was 23 and operative severity score, 8. A significant postoperative morbidity was observed in 15 (22%) of 70 patients. There was no 30-day mortality. Using exponential analysis, POSSUM predicted morbidity in 15 patients and mortality in seven patients. Thus, O/E ratios for morbidity and mortality were 1 and 0, respectively. Conclusion: POSSUM scoring performs well in predicting morbidity, but overpredicts mortality, after LC in patients aged over 80 years. An assessment of its application to other laparoscopic procedures merits evaluation. [source]