Cargando…

Perioperative risk prediction in the era of enhanced recovery: a comparison of POSSUM, ACPGBI, and E-PASS scoring systems in major surgical procedures of the colorectal surgeon

PURPOSE: This study aims to determine whether traditional risk models can accurately predict morbidity and mortality in patients undergoing major surgery by colorectal surgeons within an enhanced recovery program. METHODS: One thousand three hundred eighty patients undergoing surgery performed by co...

Descripción completa

Detalles Bibliográficos
Autores principales: Bagnall, Nigel M., Pring, Edward T., Malietzis, George, Athanasiou, Thanos, Faiz, Omar D., Kennedy, Robin H., Jenkins, John T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208691/
https://www.ncbi.nlm.nih.gov/pubmed/30078107
http://dx.doi.org/10.1007/s00384-018-3141-4
_version_ 1783366753577861120
author Bagnall, Nigel M.
Pring, Edward T.
Malietzis, George
Athanasiou, Thanos
Faiz, Omar D.
Kennedy, Robin H.
Jenkins, John T.
author_facet Bagnall, Nigel M.
Pring, Edward T.
Malietzis, George
Athanasiou, Thanos
Faiz, Omar D.
Kennedy, Robin H.
Jenkins, John T.
author_sort Bagnall, Nigel M.
collection PubMed
description PURPOSE: This study aims to determine whether traditional risk models can accurately predict morbidity and mortality in patients undergoing major surgery by colorectal surgeons within an enhanced recovery program. METHODS: One thousand three hundred eighty patients undergoing surgery performed by colorectal surgeons in a single UK hospital (2008–2013) were included. Six risk models were evaluated: (1) Physiology and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), (2) Portsmouth POSSUM (P-POSSUM), (3) ColoRectal (CR-POSSUM), (4) Elderly POSSUM (E-POSSUM), (5) the Association of Great Britain and Ireland (ACPGBI) score, and (6) modified Estimation of Physiologic Ability and Surgical Stress Score (E-PASS). Model accuracy was assessed by observed to expected (O:E) ratios and area under Receiver Operating Characteristic curve (AUC). RESULTS: Eleven patients (0.8%) died and 143 patients (10.4%) had a major complication within 30 days of surgery. All models overpredicted mortality and had poor discrimination: POSSUM 8.5% (O:E 0.09, AUC 0.56), P-POSSUM 2.2% (O:E 0.37, AUC 0.56), CR-POSSUM 7.1% (O:E 0.11, AUC 0.61), and E-PASS 3.0% (O:E 0.27, AUC 0.46). ACPGBI overestimated mortality in patients undergoing surgery for cancer 4.4% (O:E = 0.28, AUC = 0.41). Predicted morbidity was also overestimated by POSSUM 32.7% (O:E = 0.32, AUC = 0.51). E-POSSUM overestimated mortality (3.25%, O:E 0.57 AUC = 0.54) and morbidity (37.4%, O:E 0.30 AUC = 0.53) in patients aged ≥ 70 years and over. CONCLUSION: All models overestimated mortality and morbidity. New models are required to accurately predict the risk of adverse outcome in patients undergoing major abdominal surgery taking into account the reduced physiological and operative insult of laparoscopic surgery and enhanced recovery care. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00384-018-3141-4) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-6208691
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Springer Berlin Heidelberg
record_format MEDLINE/PubMed
spelling pubmed-62086912018-11-09 Perioperative risk prediction in the era of enhanced recovery: a comparison of POSSUM, ACPGBI, and E-PASS scoring systems in major surgical procedures of the colorectal surgeon Bagnall, Nigel M. Pring, Edward T. Malietzis, George Athanasiou, Thanos Faiz, Omar D. Kennedy, Robin H. Jenkins, John T. Int J Colorectal Dis Original Article PURPOSE: This study aims to determine whether traditional risk models can accurately predict morbidity and mortality in patients undergoing major surgery by colorectal surgeons within an enhanced recovery program. METHODS: One thousand three hundred eighty patients undergoing surgery performed by colorectal surgeons in a single UK hospital (2008–2013) were included. Six risk models were evaluated: (1) Physiology and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), (2) Portsmouth POSSUM (P-POSSUM), (3) ColoRectal (CR-POSSUM), (4) Elderly POSSUM (E-POSSUM), (5) the Association of Great Britain and Ireland (ACPGBI) score, and (6) modified Estimation of Physiologic Ability and Surgical Stress Score (E-PASS). Model accuracy was assessed by observed to expected (O:E) ratios and area under Receiver Operating Characteristic curve (AUC). RESULTS: Eleven patients (0.8%) died and 143 patients (10.4%) had a major complication within 30 days of surgery. All models overpredicted mortality and had poor discrimination: POSSUM 8.5% (O:E 0.09, AUC 0.56), P-POSSUM 2.2% (O:E 0.37, AUC 0.56), CR-POSSUM 7.1% (O:E 0.11, AUC 0.61), and E-PASS 3.0% (O:E 0.27, AUC 0.46). ACPGBI overestimated mortality in patients undergoing surgery for cancer 4.4% (O:E = 0.28, AUC = 0.41). Predicted morbidity was also overestimated by POSSUM 32.7% (O:E = 0.32, AUC = 0.51). E-POSSUM overestimated mortality (3.25%, O:E 0.57 AUC = 0.54) and morbidity (37.4%, O:E 0.30 AUC = 0.53) in patients aged ≥ 70 years and over. CONCLUSION: All models overestimated mortality and morbidity. New models are required to accurately predict the risk of adverse outcome in patients undergoing major abdominal surgery taking into account the reduced physiological and operative insult of laparoscopic surgery and enhanced recovery care. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00384-018-3141-4) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2018-08-04 2018 /pmc/articles/PMC6208691/ /pubmed/30078107 http://dx.doi.org/10.1007/s00384-018-3141-4 Text en © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Bagnall, Nigel M.
Pring, Edward T.
Malietzis, George
Athanasiou, Thanos
Faiz, Omar D.
Kennedy, Robin H.
Jenkins, John T.
Perioperative risk prediction in the era of enhanced recovery: a comparison of POSSUM, ACPGBI, and E-PASS scoring systems in major surgical procedures of the colorectal surgeon
title Perioperative risk prediction in the era of enhanced recovery: a comparison of POSSUM, ACPGBI, and E-PASS scoring systems in major surgical procedures of the colorectal surgeon
title_full Perioperative risk prediction in the era of enhanced recovery: a comparison of POSSUM, ACPGBI, and E-PASS scoring systems in major surgical procedures of the colorectal surgeon
title_fullStr Perioperative risk prediction in the era of enhanced recovery: a comparison of POSSUM, ACPGBI, and E-PASS scoring systems in major surgical procedures of the colorectal surgeon
title_full_unstemmed Perioperative risk prediction in the era of enhanced recovery: a comparison of POSSUM, ACPGBI, and E-PASS scoring systems in major surgical procedures of the colorectal surgeon
title_short Perioperative risk prediction in the era of enhanced recovery: a comparison of POSSUM, ACPGBI, and E-PASS scoring systems in major surgical procedures of the colorectal surgeon
title_sort perioperative risk prediction in the era of enhanced recovery: a comparison of possum, acpgbi, and e-pass scoring systems in major surgical procedures of the colorectal surgeon
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208691/
https://www.ncbi.nlm.nih.gov/pubmed/30078107
http://dx.doi.org/10.1007/s00384-018-3141-4
work_keys_str_mv AT bagnallnigelm perioperativeriskpredictionintheeraofenhancedrecoveryacomparisonofpossumacpgbiandepassscoringsystemsinmajorsurgicalproceduresofthecolorectalsurgeon
AT pringedwardt perioperativeriskpredictionintheeraofenhancedrecoveryacomparisonofpossumacpgbiandepassscoringsystemsinmajorsurgicalproceduresofthecolorectalsurgeon
AT malietzisgeorge perioperativeriskpredictionintheeraofenhancedrecoveryacomparisonofpossumacpgbiandepassscoringsystemsinmajorsurgicalproceduresofthecolorectalsurgeon
AT athanasiouthanos perioperativeriskpredictionintheeraofenhancedrecoveryacomparisonofpossumacpgbiandepassscoringsystemsinmajorsurgicalproceduresofthecolorectalsurgeon
AT faizomard perioperativeriskpredictionintheeraofenhancedrecoveryacomparisonofpossumacpgbiandepassscoringsystemsinmajorsurgicalproceduresofthecolorectalsurgeon
AT kennedyrobinh perioperativeriskpredictionintheeraofenhancedrecoveryacomparisonofpossumacpgbiandepassscoringsystemsinmajorsurgicalproceduresofthecolorectalsurgeon
AT jenkinsjohnt perioperativeriskpredictionintheeraofenhancedrecoveryacomparisonofpossumacpgbiandepassscoringsystemsinmajorsurgicalproceduresofthecolorectalsurgeon