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Willmer WFDEA, Samonge EFN, Barcia Junior OE, Bogossian GM, Assumpção LR, Marques RG. Comparison between Glasgow prognostic criteria and O-POSSUM/ P-POSSUM physiological indices in patients undergoing gastrectomy for gastric adenocarcinoma and the occurrency of early postoperative complications. Rev Col Bras Cir 2024; 51:e20243662. [PMID: 38985034 DOI: 10.1590/0100-6991e-20243662-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/12/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION Gastric cancer is still the third cause of death worldwide due to malignant neoplasms. Its prognostic indices have not yet been well defined for surgical intervention in terms of stratifying the intensity of chronic inflammation. The Glasgow Prognostic Score (GPS) and O-POSSUM and P-POSSUM Indices may constitute these standardizations and were tested to assess the association between them and the prognosis after curative gastrectomy. METHOD Retrospective observational study, analysing medical records of patients with gastric adenocarcinoma who underwent gastrectomy, from 2015 to 2021, in two hospitals in Rio de Janeiro. Surgical extension, pre, peri and postoperative clinical and laboratory data were observed, up to 30 days after surgery. Patients were layered by GPS and compared according to the Clavien-Dindo (CD) classification. Logistic regression was performed to test the association between the outcome and independent variables. RESULTS Of the 48 patients, 56.25% were female. There was difference between the groups regarding surgical extension and GPS (both with p<0.001), while O-POSSUM, P-POSSUM and age showed no difference. Factors associated with CD ≥ III-a complication in the univariate analysis were GPS (OR: 85,261; CI: 24,909- 291,831) and P-POSSUM (OR: 1,211; CI:1,044-1,404). In the multivariate analysis, the independent factors associated with CD ≥ III-a were GPS (OR:114,865; CI: 15,430-855,086), P-POSSUM (OR: 1,133; CI: 1,086-1,181) and O-POSSUM (OR: 2,238; CI: 1,790-2,797). CONCLUSION In this model, GPS, P-POSSUM and O-POSSUM predicted serious surgical complications. There is a need for further studies to establish strategies to minimize the inflammatory response in the preoperative period.
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Affiliation(s)
- William Frederic DE Araújo Willmer
- - Hospital Universitário Pedro Ernesto/UERJ, Programa de Pós-graduação em Fisiopatologia e Ciências Cirúrgicas - Rio de Janeiro - RJ - Brasil
| | | | | | | | - Lia Roque Assumpção
- - Hospital Universitário Pedro Ernesto/UERJ, Programa de Pós-graduação em Fisiopatologia e Ciências Cirúrgicas - Rio de Janeiro - RJ - Brasil
| | - Ruy Garcia Marques
- - Hospital Universitário Pedro Ernesto/UERJ, Programa de Pós-graduação em Fisiopatologia e Ciências Cirúrgicas - Rio de Janeiro - RJ - Brasil
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Sevinyan L, Asaalaarchchi H, Tailor A, Williams P, Evans M, Hodnett D, Arakkal D, Prabhu P, Flint MS, Madhuri TK. Head-to-Head Comparison: P-POSSUM and ACS-NSQIP ® in Predicting Perioperative Risk in Robotic Surgery for Gynaecological Cancers. Cancers (Basel) 2024; 16:2297. [PMID: 39001360 PMCID: PMC11240461 DOI: 10.3390/cancers16132297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/02/2024] [Accepted: 06/17/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose: In this retrospective pilot study, we aim to evaluate the accuracy and reliability of the P-POSSUM and ACS-NSQIP surgical risk calculators in predicting postoperative complications in gynaecological-oncological (GO) robotic surgery (RS). Methods: Retrospective data collection undertaken through a dedicated GO database and patient notes at a tertiary referral cancer centre. Following data lock with the actual post-op event/complication, the risk calculators were used to measure predictive scores for each patient. Baseline analysis of 153 patients, based on statistician advice, was undertaken to evaluate P-POSSUM and ACS-NSQIP validity and relevance in GO patients undergoing RS performed. Results: P-POSSUM reports on mortality and morbidity only; ACS-NSQIP reports some individual complications as well. ACS-NSQIP risk prediction was most accurate for venous thromboembolism (VTE) (area under the curve (AUC)-0.793) and pneumonia (AUC-0.657) and it showed 90% accuracy in prediction of five major complications (Brier score 0.01). Morbidity was much better predicted by ACS-NSQIP than by P-POSSUM (AUC-0.608 vs. AUC-0.551) with the same result in mortality prediction (Brier score 0.0000). Moreover, a statistically significant overestimation of morbidity has been shown by the P-POSSUM calculator (p = 0.018). Conclusions: Despite the limitations of this pilot study, the ACS-NSQIP risk calculator appears to be a better predictor of major complications and mortality, making it suitable for use by GO surgeons as an informed consent tool. Larger data collection and analyses are ongoing to validate this further.
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Affiliation(s)
- Lusine Sevinyan
- Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
- School of Applied Sciences, University of Brighton, Brighton BN2 4GJ, UK
| | - Hasanthi Asaalaarchchi
- Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
| | - Anil Tailor
- Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
| | - Peter Williams
- Department of Maths and Statistics, University of Surrey, Guildford GU2 7XH, UK
| | - Matthew Evans
- Department of Anaesthetics, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
| | - Darragh Hodnett
- Department of Anaesthetics, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
| | - Darshana Arakkal
- Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
| | - Pradeep Prabhu
- Department of Anaesthetics, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
| | - Melanie S Flint
- School of Applied Sciences, University of Brighton, Brighton BN2 4GJ, UK
| | - Thumuluru Kavitha Madhuri
- Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
- School of Applied Sciences, University of Brighton, Brighton BN2 4GJ, UK
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Stanley C, Lennon D, Moran C, Vasireddy A, Rowan F. Risk scoring models for patients with proximal femur fractures: Qualitative systematic review assessing 30-day mortality and ease of use. Injury 2023; 54:111017. [PMID: 37729811 DOI: 10.1016/j.injury.2023.111017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 08/21/2023] [Accepted: 09/02/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Hip fractures are a common orthopaedic injury affecting a particularly frail and vulnerable patient cohort. They are at risk of many complications, including prolonged length of stay and mortality. Efforts to identify those at high risk may be beneficial. Over 25 risk prediction models are published for patients with hip fractures. AIM The primary aim of this study was to assess the performance of predictor scores in predicting 30-day mortality. The secondary aim was to assess the ease of use of these systems. METHODS A qualitative systematic review was performed. A search was conducted on online databases, including PubMed, CINAHL, Clinical Trials.gov, Cochrane, DARE, EMBASE, SCOPUS, and Web of Science.. The terms fragility hip fractures and risk prediction models were utilised while performing the search. These were then expanded using Boolean operators and similar terms. Search results were imported to Covidence. Primary observational studies using one or more hip fracture mortality prediction models and 30-day mortality as an outcome were included. Systematic reviews and studies on specific patient groups defined other medical conditions (e.g. COVID positive or dialysis patients) were excluded. RESULTS 3,101 studies were screened following duplicate removal. 34 papers were included in the review, in which 23 scoring systems were reported. Six of these were pre-operative and reported in multiple studies. Most demonstrated appropriate fit and fair discrimination. Five of the six pre-operative scoring systems examined, displayed appropriate ease of use, allowing risk calculation at the time of admission. CONCLUSION Nottingham Hip Fracture Score remains the most extensive reported scoring system and performs fair overall with AUROCs of 0.64-0.80 and good fit in calibration across all studies. However, new systems utilise many similar predictors. There is a need for the standardisation of publications on scoring systems to allow further systematic review and meta-analyses.
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Affiliation(s)
- Ciarán Stanley
- Department of Trauma and Orthopaedics, University Hospital Waterford, Ireland.
| | - David Lennon
- Department of Trauma and Orthopaedics, University Hospital Waterford, Ireland
| | - Conor Moran
- Department of Trauma and Orthopaedics, University Hospital Limerick, Ireland
| | | | - Fiachra Rowan
- Department of Trauma and Orthopaedics, University Hospital Waterford, Ireland
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Grantham JP, Hii A, Shenfine J. Combined and intraoperative risk modelling for oesophagectomy: A systematic review. World J Gastrointest Surg 2023; 15:1485-1500. [PMID: 37555117 PMCID: PMC10405120 DOI: 10.4240/wjgs.v15.i7.1485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 03/13/2023] [Accepted: 05/22/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Oesophageal cancer is the eighth most common malignancy worldwide and is associated with a poor prognosis. Oesophagectomy remains the best prospect for a cure if diagnosed in the early disease stages. However, the procedure is associated with significant morbidity and mortality and is undertaken only after careful consideration. Appropriate patient selection, counselling and resource allocation is essential. Numerous risk models have been devised to guide surgeons in making these decisions. AIM To evaluate which multivariate risk models, using intraoperative information with or without preoperative information, best predict perioperative oesophagectomy outcomes. METHODS A systematic review of the MEDLINE, EMBASE and Cochrane databases was undertaken from 2000-2020. The search terms used were [(Oesophagectomy) AND (Model OR Predict OR Risk OR score) AND (Mortality OR morbidity OR complications OR outcomes OR anastomotic leak OR length of stay)]. Articles were included if they assessed multivariate based tools incorporating preoperative and intraoperative variables to forecast patient outcomes after oesophagectomy. Articles were excluded if they only required preoperative or any post-operative data. Studies appraising univariate risk predictors such as preoperative sarcopenia, cardiopulmonary fitness and American Society of Anesthesiologists score were also excluded. The review was conducted following the preferred reporting items for systematic reviews and meta-analyses model. All captured risk models were appraised for clinical credibility, methodological quality, performance, validation and clinical effectiveness. RESULTS Twenty published studies were identified which examined eleven multivariate risk models. Eight of these combined preoperative and intraoperative data and the remaining three used only intraoperative values. Only two risk models were identified as promising in predicting mortality, namely the Portsmouth physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and POSSUM scores. A further two studies, the intraoperative factors and Esophagectomy surgical Apgar score based nomograms, adequately forecasted major morbidity. The latter two models are yet to have external validation and none have been tested for clinical effectiveness. CONCLUSION Despite the presence of some promising models in forecasting perioperative oesophagectomy outcomes, there is more research required to externally validate these models and demonstrate clinical benefit with the adoption of these models guiding postoperative care and allocating resources.
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Affiliation(s)
- James Paul Grantham
- Department of General Surgery, Modbury Hospital, Modbury 5092, South Australia, Australia
| | - Amanda Hii
- Department of General Surgery, Modbury Hospital, Modbury 5092, South Australia, Australia
| | - Jonathan Shenfine
- Department of General Surgical Unit, Jersey General Hospital, Saint Helier JE1 3QS, Jersey, United Kingdom
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Maeda K, Kuriyama N, Ito T, Gyoten K, Hayasaki A, Fujii T, Iizawa Y, Murata Y, Tanemura A, Kishiwada M, Mizuno S. Safety and benefits of major hepatectomy with extrahepatic bile duct resection in older perihilar cholangiocarcinoma patients. Langenbecks Arch Surg 2022; 407:2861-2872. [PMID: 35996005 DOI: 10.1007/s00423-022-02654-x] [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] [Received: 04/24/2022] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To evaluate the safety and benefits of major hepatectomy with extrahepatic bile duct resection in older perihilar cholangiocarcinoma patients and to identify possible predictors of surgical mortality. METHODS We retrospectively analyzed the data of 102 consecutive patients who underwent major hepatectomy with extrahepatic bile duct resection for perihilar cholangiocarcinoma in our institution between 2004 and 2021. The patients were included and divided into two groups: older patients ≥ 75 years and non-older patients < 75 years. Patient characteristics, preoperative nutritional and operative risk scores, intraoperative details, postoperative outcomes, and long-term prognosis were compared between the groups. Univariate and multivariate analyses were used to identify the predictors of 90-day mortality after major hepatectomy with extrahepatic bile duct resection. RESULTS Significant differences were identified for some preoperative surgical risk scores, but not for nutritional scores. Older patients had a higher morbidity rate of respiratory complications (p = 0.016), but there were no significant differences in overall (p = 0.735) or disease-specific survival (p = 0.858). A high Dasari's score was identified as an independent predictive factor of 90-day mortality. CONCLUSIONS Major hepatectomy with extrahepatic bile duct resection can be performed for optimally selected older and younger patients with perihilar cholangiocarcinoma, resulting in a good prognosis. However, indications for extended surgery should be recognized. Dasari's preoperative risk score may be a good predictor of 90-day mortality.
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Affiliation(s)
- Koki Maeda
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
- Regional Medical Support Center, Mie University Hospital, Tsu city, Mie, Japan
| | - Naohisa Kuriyama
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan.
| | - Takahiro Ito
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Kazuyuki Gyoten
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Aoi Hayasaki
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Takehiro Fujii
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Yusuke Iizawa
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Yasuhiro Murata
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Akihiro Tanemura
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Masashi Kishiwada
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Shugo Mizuno
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
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Shi MK, Mei YQ, Shi JL. Short- (30-90 days) and mid-term (1-3 years) outcomes and prognostic factors of patients with esophageal cancer undergoing surgical treatments. World J Clin Cases 2022; 10:7708-7719. [PMID: 36158480 PMCID: PMC9372832 DOI: 10.12998/wjcc.v10.i22.7708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/30/2021] [Accepted: 06/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The factors influencing the prognosis of patients with esophageal cancer vary among studies and are still poorly known.
AIM To determine the factors associated with survival in patients with esophageal cancer.
METHODS This retrospective study included patients with esophageal cancer admitted between January 2017 and March 2020 at Heping Hospital Affiliated to Changzhi Medical College. All patients were treated according to the available guidelines. Follow-up was censored in October 2020. Univariable and multivariable Cox regression analyses were used to determine the independent risk factors for overall survival (OS).
RESULTS In total, 307 patients were included. Their median age was 64 (range, 44-79) years, 63.5% were male, and the median disease course was 2 (0.1-36) months. The median tumor size was 3 (0-10) cm. Most patients were T3 (29.6%), N0 (70.0%). Most tumors were grade 2 (48.2%), and 87.3% were squamous cell carcinoma. The in-hospital mortality was 16.9%, the 30-day mortality was 19.9%, and the 90-day mortality was 25.4%. The cumulative OS rates at the last follow-up were 82.1% (95%CI: 67.7%-96.5%) for stage 0/I/II and 47.4% (95%CI: 16.5-78.6%) for stage III/IVA (P < 0.001). The multivariable analysis showed that creatinine levels (HR = 1.02, 95%CI: 1.00-1.03, P = 0.050), pTNM III/IVA (HR = 4.19, 95%CI: 2.19-8.01, P < 0.001), adjuvant radiotherapy and/or chemotherapy (HR = 0.23, 95%CI: 0.11-0.49), and the Comprehensive Complication Index (CCI) (HR = 1.02, 95%CI: 1.004-1.03, P = 0.011) were independently associated with OS.
CONCLUSION The survival of patients with esophageal cancer is poor, especially those with pTNM III/IVA. pTNM stage III/IVA, CCI, and adjuvant therapy (radiotherapy and/or chemotherapy) are independently associated with OS.
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Affiliation(s)
- Meng-Kun Shi
- Department of Cardiothoracic Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Yun-Qing Mei
- Department of Cardiothoracic Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Jia-Lun Shi
- Department of Cardiothoracic Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi Province, China
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Moraes CMTDE, Corrêa LDEM, Procópio RJ, Carmo GALDO, Navarro TP. Tools and scores for general and cardiovascular perioperative risk assessment: a narrative review. Rev Col Bras Cir 2022; 49:e20223124. [PMID: 35319563 PMCID: PMC10578796 DOI: 10.1590/0100-6991e-20223124] [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] [Received: 07/08/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
The number of surgical procedures in the world is large and in Brazil it has been expressing a growth trend higher than the population growth. In this context, perioperative risk assessment safeguards the optimization of the outcomes sought by the procedures. For this evaluation, anamnesis and physical examination constitute an irreplaceable initial stage which may or may not be followed by complementary exams, interventions for clinical stabilization and application of risk estimation tools. The use of these tools can be very useful in order to obtain objective data for decision making by weighing surgical risk and benefit. Global and cardiovascular risk assessments are of greatest interest in the preoperative period, however information about their methods is scattered in the literature. Some tools such as the American Society of Anesthesiologists Physical Status (ASA PS) and the Revised Cardiac Risk Index (RCRI) are more widely known, while others are less known but can provide valuable information. Here, the main indices, scores and calculators that address general and cardiovascular perioperative risk were detailed.
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Affiliation(s)
| | | | - Ricardo Jayme Procópio
- - Universidade Federal de Minas Gerais, Hospital das Clínicas, Unidade Endovascular - Belo Horizonte - MG - Brasil
| | | | - Tulio Pinho Navarro
- - Universidade Federal de Minas Gerais, Departamento de Cirurgia - Belo Horizonte - MG - Brasil
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Meshikhes AWN. POSSUM scoring system and its modifications: The urgent need for a reliable preoperative tool for predicting postoperative morbidity and mortality. Int J Surg 2020; 78:21. [PMID: 32302747 DOI: 10.1016/j.ijsu.2020.03.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 11/29/2022]
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Morbidity After Esophagectomy With Three-Field Lymph Node Dissection in Patients With Esophageal Cancer: Looking for the Best Predictive Model. Int Surg 2020. [DOI: 10.9738/intsurg-d-18-00012.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
Esophagectomy with three-field lymphadenectomy (3FLD) is a potentially curative treatment option for resectable esophageal cancer (EC), which is associated with significant morbidity. Risk scores are useful for patient assessment; this study compares 7 different scores and indexes to find the best model for predicting morbidity in patients undergoing 3FLD.
Methods
Six years of data from January 2010 to January 2016 were reviewed, patients with EC who underwent 3FLD were retrospectively scored using 4 predictive scores and 3 predictive index models. Postoperative morbidity was assessed according to the extended Clavien-Dindo classification. The outcomes were the presence and severity of morbidity. Validation was performed by calculating the area under the ROC curve and by the assessment of collinearity among the variables independently associated with morbidity in the overall model to determine the best predictive model.
Results
We included 230 patients were included in the final analysis. Complications after 3FLD occurred in 168 patients (73%; minor complications, n = 96 [41%]; major complications, n=72 [31%]). The AUC values (<0.7) indicated that all scores and indexes had poor discrimination power in predicting the presence and severity of morbidity. Overall, the Steyerberg score was associated with the lowest risk of misestimation in predicting morbidity (P = 0.0330).
Conclusion
No score or index could predict the presence or severity of morbidity after 3FLD with good discrimination power. Age (>68 years) was the most critical factor affecting morbidity. The Steyerberg score model, based on the addition and subtraction of risk values was the best model for predicting morbidity after 3FLD.
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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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Eichelmann AK, Saidi M, Lindner K, Lenschow C, Palmes D, Pascher A, Hummel R. Impact of preoperative risk factors on outcome after gastrectomy. World J Surg Oncol 2020; 18:17. [PMID: 31980026 PMCID: PMC6982377 DOI: 10.1186/s12957-020-1790-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/12/2020] [Indexed: 02/07/2023] Open
Abstract
Background Gastrectomy is associated with relevant postoperative morbidity. However, outcome of surgery can be improved by careful selection of patients. The objective of the current study was therefore to identify preoperative risk factors that might impact on patients’ further outcome after surgical resection. Methods Preoperative risk factors having respectively different surgical risk scores for major complex surgery (including Cologne Risk Score, p-/o-POSSUM, and NSQIP risk score) of patients that underwent gastrectomy for AEG II/III tumors and gastric cancer were correlated with complications according to Clavien-Dindo and outcome. Patients who underwent surgery in palliative intention were excluded from further analysis. Results Subtotal gastrectomy was performed in 23%, gastrectomy in 59%, and extended gastrectomy in 18% in a total of 139 patients (mean age: 64 years old). Thirty six percent experienced a minor complication (Dindo I-II) and 24% a major complication (Dindo III-V), which resulted in a prolonged hospital stay (p < 0.001). In-hospital mortality (=Dindo V) was 2.5%. Besides age, type of surgical procedure impacted on complications with extended gastrectomy showing the highest risk (p = 0.005). The o-POSSUM score failed to predict mortality accurately. We observed a highly positive correlation between predicted morbidity respectively mortality and occurrence of complications estimated by p-POSSUM (p = 0.005), Cologne Risk (p = 0.007), and NSQIP scores (p < 0.001). Conclusion The results demonstrate a significant association between different risk scores and occurrence of complications following gastrectomy. The p-POSSUM, Cologne Risk, and NSQIP score exhibited superior performance than the o-POSSUM score. Therefore, these scores might allow identification and selection of high-risk patients and thus might be highly useful for clinical decision making.
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Affiliation(s)
- Ann-Kathrin Eichelmann
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, W1, 48149, Münster, Germany.
| | - Meltem Saidi
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, W1, 48149, Münster, Germany
| | - Kirsten Lindner
- Department of Surgery, University Hospital of Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Christina Lenschow
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Daniel Palmes
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, W1, 48149, Münster, Germany
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, W1, 48149, Münster, Germany
| | - Richard Hummel
- Department of Surgery, University Hospital of Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
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Dilaver NM, Gwilym BL, Preece R, Twine CP, Bosanquet DC. Systematic review and narrative synthesis of surgeons' perception of postoperative outcomes and risk. BJS Open 2019; 4:16-26. [PMID: 32011813 PMCID: PMC6996626 DOI: 10.1002/bjs5.50233] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/24/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The accuracy with which surgeons can predict outcomes following surgery has not been explored in a systematic way. The aim of this review was to determine how accurately a surgeon's 'gut feeling' or perception of risk correlates with patient outcomes and available risk scoring systems. METHODS A systematic review was undertaken in accordance with PRISMA guidelines. A narrative synthesis was performed in accordance with the Guidance on the Conduct of Narrative Synthesis In Systematic Reviews. Studies comparing surgeons' preoperative or postoperative assessment of patient outcomes were included. Studies that made comparisons with risk scoring tools were also included. Outcomes evaluated were postoperative mortality, general and operation-specific morbidity and long-term outcomes. RESULTS Twenty-seven studies comprising 20 898 patients undergoing general, gastrointestinal, cardiothoracic, orthopaedic, vascular, urology, endocrine and neurosurgical operations were included. Surgeons consistently overpredicted mortality rates and were outperformed by existing risk scoring tools in six of seven studies comparing area under receiver operating characteristic (ROC) curves (AUC). Surgeons' prediction of general morbidity was good, and was equivalent to, or better than, pre-existing risk prediction models. Long-term outcomes were poorly predicted by surgeons, with AUC values ranging from 0·51 to 0·75. Four of five studies found postoperative risk estimates to be more accurate than those made before surgery. CONCLUSION Surgeons consistently overestimate mortality risk and are outperformed by pre-existing tools; prediction of longer-term outcomes is also poor. Surgeons should consider the use of risk prediction tools when available to inform clinical decision-making.
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Affiliation(s)
- N M Dilaver
- Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK.,Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - B L Gwilym
- Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | - R Preece
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - C P Twine
- Division of Population Medicine, Cardiff University, Cardiff, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - D C Bosanquet
- Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
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Madhavan S, Shelat VG, Soong SL, Woon WWL, Huey T, Chan YH, Junnarkar SP. Predicting morbidity of liver resection. Langenbecks Arch Surg 2018; 403:359-369. [PMID: 29417211 DOI: 10.1007/s00423-018-1656-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/25/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Multiple models have attempted to predict morbidity of liver resection (LR). This study aims to determine the efficacy of American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator and the Physiological and Operative Severity Score in the enUmeration of Mortality and Morbidity (POSSUM) in predicting post-operative morbidity in patients who underwent LR. METHODS A retrospective analysis was conducted on patients who underwent elective LR. Morbidity risk was calculated with the ACS-NSQIP surgical risk calculator and POSSUM equation. Two models were then constructed for both ACS-NSQIP and POSSUM-(1) the original risk probabilities from each scoring system and (2) a model derived from logistic regression of variables. Discrimination, calibration, and overall performance for ACS-NSQIP and POSSUM were compared. Sub-group analysis was performed for both primary and secondary liver malignancies. RESULTS Two hundred forty-five patients underwent LR. Two hundred twenty-three (91%) had malignant liver pathologies. The post-operative morbidity, 90-day mortality, and 30-day mortality rate were 38.3%, 3.7%, and 2.4% respectively. ACS-NSQIP showed superior discriminative ability, calibration, and performance to POSSUM (p = 0.03). Hosmer-Lemeshow plot demonstrated better fit of the ACS-NSQIP model than POSSUM in predicting morbidity. CONCLUSION In patients undergoing LR, the ACS-NSQIP surgical risk calculator was superior to POSSUM in predicting morbidity risk.
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Affiliation(s)
- Sudharsan Madhavan
- Ministry of Health Holdings, 1 Maritime Square, #11-25 HarbourFront Centre, Singapore, 099253, Republic of Singapore
| | - Vishal G Shelat
- Hepato-Pancreatico-Biliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore
| | - Su-Lin Soong
- Hepato-Pancreatico-Biliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore
| | - Winston W L Woon
- Hepato-Pancreatico-Biliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore
| | - Terence Huey
- Hepato-Pancreatico-Biliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore
| | - Yiong H Chan
- Biostatistics Unit, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore
| | - Sameer P Junnarkar
- Hepato-Pancreatico-Biliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore.
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Mora A, Nakajima Y, Okada T, Tokairin Y, Kawada K, Kawano T. Comparative Study of Predictive Mortality Scores in Esophagectomy with Three-Field Lymph Node Dissection in Patients with Esophageal Cancer. Dig Surg 2018; 36:67-75. [PMID: 29393197 DOI: 10.1159/000486551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 12/30/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIM Esophagectomy is still the best therapeutic option for curing resectable esophageal cancer (EC). Radical surgical resection with three-field lymphadenectomy (3FLD) is a potentially curative treatment option. We compared the predictive accuracy of 5 different scores in patients with EC who underwent 3FLD. METHODS Five years' worth of medical records in a single institution were analyzed (January 2010 to January 2015) from 311 patients who underwent esophagectomy for EC. We selected 191 in whom 3FLD was performed. Mortality was calculated based on 5 predictive scores. Outcomes measures were intraoperative mortality, 30-day mortality, and 1- and 2-year mortality after surgery. RESULTS Intraoperative mortality and 30-day mortality after surgery was 0%; 1 and 2-year mortality were 19.8 and 31.4%, respectively. The area under the curve showed poor discriminatory power for all 5 scores (<0.7). In one-way analysis of variance, for 1 year mortality, Portsmouth-Physiological and Operative Severity Score for mortality (P-Possum) was significant (p = 0.0424); in a multivariable analysis for 2-year mortality, P-Possum (p < 0.0001) remained significant. CONCLUSION There is no accurate prognosis score for esophagectomy in patients who undergo high-risk procedures like 3FLD. New scores are needed to predict the mortality after 3FLD with good discriminatory power. Independent factors affect survival and may function as the baseline for obtaining a new accurate mortality score.
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Kalkan Ç, Kartal AÇ, Karakaya F, Tüzün A, Soykan I. Utility of Three Prognostic Risk Scores in Predicting Outcomes in Elderly Non-Malignant Patients after Percutaneous Gastrostomy. J Nutr Health Aging 2017; 21:1344-1348. [PMID: 29188899 DOI: 10.1007/s12603-016-0853-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND/OBJECTIVES Percutaneous endoscopic gastrostomy is a method of providing enteral feeding to patients who cannot take adequate oral nutrition. The aims of this study were to determine the performance of malnutrition and mortality scoring systems for predicting short and long-term mortality in elderly patients who had undergone gastrostomy procedure due to non-malignant conditions. DESIGN Retrospective cohort study. SETTING University hospital in Turkey. PARTICIPANTS 155 individuals aged 65 and older principally hospitalized for non-malignant diseases and require percutaneous endoscopic gastrostomy. MEASUREMENTS "Geriatric Nutritional Risk Index", "Malnutrition Universal Screening Tool" (MUST) and "Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity" (P-POSSUM) scores were calculated. The ability of these scores to predict mortality was determined. RESULTS The mean survival period was 9.59±6.0 months and mortality rate was 80.6%. The performance of "Geriatric Nutritional Risk Index" was superior to MUST and P-POSSUM in predicting long-term survival of gastrostomy patients; 94.1% of patients were alive with a cut-off value of 90 for "Geriatric Nutritional Risk Index" (sensitivity: 92% CI 85.9-95.6 and specificity: 90% CI 74.3-96.5). Survival analysis showed that patients (n=7) with a "Geriatric Nutritional Risk Index" score of > 98 before the gastrostomy had the longest survival time, while patients (n=102) with a "Geriatric Nutritional Risk Index" score of < 82 had the worst outcome. CONCLUSIONS A scoring system such as "Geriatric Nutritional Risk Index" should be considered as a risk scoring system for predicting early and late mortality at gastrostomy and also assist in making decisions such as timing of gastrostomy procedure.
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Affiliation(s)
- Ç Kalkan
- Irfan Soykan, Ankara University Medical School, Gastroenterology, Sihhiye, 06100, Ankara, Turkey, Tel: +90 312 5082759, Fax: +90 312 3103446, e-mail:
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Inokuchi M, Otsuki S, Murase H, Kawano T, Kojima K. Feasibility of laparoscopy-assisted gastrectomy for patients with poor physical status: A propensity-score matching study. Int J Surg 2016; 31:47-51. [PMID: 27260314 DOI: 10.1016/j.ijsu.2016.05.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/11/2016] [Accepted: 05/29/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopically-assisted gastrectomy (LAG) has been established to be a minimally invasive treatment for early gastric cancer. However, few studies have shown the feasibility of LAG in patients with risky comorbidities according to the American Society of Anesthesiologists physical status (ASA-PS) classification. We performed this retrospective cohort study to assess the feasibility of LG in patients with an ASA-PS class of 3 or higher. METHODS We retrospectively identified 214 patients with an ASA-PS class of 3 or 4 among 1192 patients who underwent radical gastrectomy with lymph-node dissection between 1999 and 2014 in our hospital. Finally, 106 patients were generated by propensity-score matching between LAG and open gastrectomy (OG). Postoperative complications were compared between LAG and OG. RESULT The overall incidence of complications was the same in LAG (30%) and OG (30%). Surgical complications were similar in LAG and OG (19% and 17%, p = 0.80). Medical complications also did not differ significantly between LAG and OG (21% and 15%, p = 0.45). CONCLUSION LAG was a feasible procedure for patients with gastric cancer who had an ASA-PS class of 3 or 4 and could undergo general anesthesia. LAG can become an optional treatment for such risky patients.
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Affiliation(s)
- Mikito Inokuchi
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan.
| | - Sho Otsuki
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Hideaki Murase
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Tatsuyuki Kawano
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Kazuyuki Kojima
- Department of Minimally Invasive Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
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Kose I, Zİncircioglu C, Çakmak M, Cabbaroglu G, Senoglu N, Gonullu M. Postoperative patients in the intensive care unit: Identifying those who do not really need it. J Crit Care 2015; 30:1295-8. [DOI: 10.1016/j.jcrc.2015.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/28/2015] [Accepted: 08/20/2015] [Indexed: 11/29/2022]
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Janowak CF, Blasberg JD, Taylor L, Maloney JD, Macke RA. The Surgical Apgar Score in esophagectomy. J Thorac Cardiovasc Surg 2015; 150:806-12. [DOI: 10.1016/j.jtcvs.2015.07.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 05/12/2015] [Accepted: 07/03/2015] [Indexed: 01/09/2023]
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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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Filip B, Scarpa M, Cavallin F, Cagol M, Alfieri R, Saadeh L, Ancona E, Castoro C. Postoperative outcome after oesophagectomy for cancer: Nutritional status is the missing ring in the current prognostic scores. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2015; 41:787-94. [DOI: 10.1016/j.ejso.2015.02.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/08/2015] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
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Warnell I, Chincholkar M, Eccles M. Predicting perioperative mortality after oesophagectomy: a systematic review of performance and methods of multivariate models. Br J Anaesth 2015; 114:32-43. [DOI: 10.1093/bja/aeu294] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Inokuchi M, Kato K, Sugita H, Otsuki S, Kojima K. Impact of comorbidities on postoperative complications in patients undergoing laparoscopy-assisted gastrectomy for gastric cancer. BMC Surg 2014; 14:97. [PMID: 25416543 PMCID: PMC4251931 DOI: 10.1186/1471-2482-14-97] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 11/11/2014] [Indexed: 12/12/2022] Open
Abstract
Background Comorbidity is a predictor of postoperative complications (PCs) in gastrectomy. However, it remains unclear which comorbidities are predictors of PCs in patients who undergo laparoscopy-assisted gastrectomy (LAG). Clinically, insufficient lymphadenectomy (LND) is sometimes performed in high-risk patients, although the impact on PCs and outcomes remains unclear. Methods We retrospectively studied 529 patients with gastric cancer (GC) who underwent LAG. PCs were defined as grade 2 or higher events according to the Clavien-Dindo classification. We evaluated various comorbidities as risk factors for PCs and examined the impact of insufficient LND on PCs in patients with risky comorbidities. Result A total of 87 (16.4%) patients had PCs. There was no PC-related death. On univariate analysis, heart disease, central nervous system (CNS) disease, liver disease, renal dysfunction, and restrictive pulmonary dysfunction were significantly associated with PCs. Both liver disease and heart disease were significant independent risk factors for PCs on multivariate analysis (odds ratio [OR] = 3.25, p = 0.022; OR = 2.36, p = 0.017, respectively). In patients with one or more risky comorbidity, insufficient LND did not significantly decrease PCs (p = 0.42) or shorten GC-specific survival (p = 0.25). Conclusion In patients who undergo LAG for GC, the presence of heart disease or liver disease is an independent risk factor for PC. Insufficient LND (for example, D1+ for advanced GC) might be permissible in high-risk patients, because although it did not reduce PCs, it had no negative impact on GC-specific survival.
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Affiliation(s)
- Mikito Inokuchi
- Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan.
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Scott S, Lund JN, Gold S, Elliott R, Vater M, Chakrabarty MP, Heinink TP, Williams JP. An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting. BMC Anesthesiol 2014; 14:104. [PMID: 25469106 PMCID: PMC4247634 DOI: 10.1186/1471-2253-14-104] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/28/2014] [Indexed: 12/20/2022] Open
Abstract
Background POSSUM and P-POSSUM are used in the assessment of outcomes in surgical patients. Neither scoring systems’ accuracy has been established where a level 1 critical care facility (level 1 care ward) is available for perioperative care. We compared POSSUM and P-POSSUM predicted with observed mortality on a level 1 care ward. Methods A prospective, observational study was performed between May 2000 and June 2008. POSSUM and P-POSSUM scores were calculated for all postoperative patients who were admitted to the level 1 care ward. Data for post-operative mortality were obtained from hospital records for 2552 episodes of patient care. Observed vs expected mortality was compared using receiver operating characteristic (ROC) curves and the goodness of fit assessed using the Hosmer-Lemeshow equation. Results ROC curves show good discriminative ability between survivors and non-survivors for POSSUM and P-POSSUM. Physiological score had far higher discrimination than operative score. Both models showed poor calibration and poor goodness of fit (Hosmer-Lemeshow). Observed to expected (O:E) mortality ratio for POSSUM and P-POSSUM indicated significantly fewer than expected deaths in all deciles of risk. Conclusions Our data suggest a 30-60% reduction in O:E mortality. We suggest that the use of POSSUM models to predict mortality in patients admitted to level 1 care ward is inappropriate or that a recalibration of POSSUM is required to make it useful in a level 1 care ward setting.
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Affiliation(s)
- Sarah Scott
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, DE22 3DT UK
| | - Jonathan N Lund
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, DE22 3DT UK ; MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Nottingham, NG7 2UH UK
| | - Stuart Gold
- Department of Anesthesia and Critical Care, Royal Derby Hospital, Derby, DE22 3NE UK
| | - Richard Elliott
- Department of Anesthesia and Critical Care, Royal Derby Hospital, Derby, DE22 3NE UK
| | - Mair Vater
- Department of Anesthesia and Critical Care, Royal Derby Hospital, Derby, DE22 3NE UK
| | - Mallicka P Chakrabarty
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, DE22 3DT UK
| | - Thomas P Heinink
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, DE22 3DT UK ; Department of Anesthesia and Critical Care, Royal Derby Hospital, Derby, DE22 3NE UK
| | - John P Williams
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, DE22 3DT UK ; Department of Anesthesia and Critical Care, Royal Derby Hospital, Derby, DE22 3NE UK ; MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Nottingham, NG7 2UH UK
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王 蓉, 高 德, 龚 卫, 梁 致. [Value of modified POSSUM scoring system on predicting operation risk
in elderly NSCLC patients]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:669-73. [PMID: 25248708 PMCID: PMC6000503 DOI: 10.3779/j.issn.1009-3419.2014.09.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/08/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- 蓉 王
- />100853 北京,解放军总医院南楼综合外科Surgery Department of Nan-lou, Chinese PLA General Hospital, Beijing 100853, China
| | - 德伟 高
- />100853 北京,解放军总医院南楼综合外科Surgery Department of Nan-lou, Chinese PLA General Hospital, Beijing 100853, China
| | - 卫琴 龚
- />100853 北京,解放军总医院南楼综合外科Surgery Department of Nan-lou, Chinese PLA General Hospital, Beijing 100853, China
| | - 致如 梁
- />100853 北京,解放军总医院南楼综合外科Surgery Department of Nan-lou, Chinese PLA General Hospital, Beijing 100853, China
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Individual risk modelling for esophagectomy: a systematic review. J Gastrointest Surg 2014; 18:1532-42. [PMID: 24760219 DOI: 10.1007/s11605-014-2524-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/31/2014] [Indexed: 01/31/2023]
Abstract
INTRODUCTION A number of models have been applied to predict outcomes from esophagectomy. This systematic review aimed to compare their clinical credibility, methodological quality and performance. METHODS A systematic review of the PubMed, EMBASE and Cochrane databases was performed in October 2012. Model and study quality were appraised using the framework of Minne et al. RESULTS Twenty studies were included in total; these were heterogeneous, retrospective and conducted over a number of years; all models were generated via logistic regression. Overall mortality was high, and consequently not representative of current practice. Clinical credibility and methodological quality were variable, with frequent failure to perform internal validation and variable presentation of calibration and discrimination metrics. P-POSSUM demonstrated the best calibration and discrimination for predicting mortality. Other than the Southampton score (which has yet to be externally validated) and the Amsterdam score, no studies had utility in predicting complications. CONCLUSION Whilst a number of models have been developed, adapted or trialled, due to numerous limitations, larger and more contemporary studies are required to develop and validate models further. The role of alternative techniques such as decision tree analysis and artificial neural networks is not known.
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Wang H, Wang H, Chen T, Liang X, Song Y, Wang J. Evaluation of the POSSUM, P-POSSUM and E-PASS scores in the surgical treatment of hilar cholangiocarcinoma. World J Surg Oncol 2014; 12:191. [PMID: 24961847 PMCID: PMC4079624 DOI: 10.1186/1477-7819-12-191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/08/2014] [Indexed: 02/08/2023] Open
Abstract
Background The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) model, its Portsmouth (P-POSSUM) modification and the Estimation of physiologic ability and surgical stress (E-PASS) are three surgical risk scoring systems used extensively to predict postoperative morbidity and mortality in general surgery. The aim was to undertake the first study of the predictive value of these models in patients undergoing surgical treatment of hilar cholangiocarcinoma. Methods A retrospective analysis was performed on data collected prospectively over a 10-year interval from January 2003 to December 2012. The morbidity and mortality risks were calculated using the POSSUM, P-POSSUM and E-PASS equations. Results One hundred patients underwent surgical treatment of hilar cholangiocarcinoma. Complications were seen in 52 of 100 patients (52.0%). There were 10 postoperative in-hospital deaths (10.0%). Of 31 preoperative and intraoperative variables studied, operative type (P = 0.000), preoperative serum albumin (P = 0.003) and aspartate aminotransferase (P = 0.029) were found to be factors multivariate associated with postoperative complications. Intraoperative blood loss (P = 0.015), Bismuth-Corlette classification (P = 0.033) and preoperative hemoglobin (P = 0.041) were independent factors multivariate associated with in-hospital death. The POSSUM system predicted morbidity risk effectively with no significant lack of fit (P = 0.488) and an area under the ROC curve (AUC) of 0.843. POSSUM, P-POSSUM and E-PASS scores showed no significant lack of fit in calculating the mortality risk (P >0.05) and all yielded an AUC value exceeding 0.8. POSSUM had significantly more accuracy in predicting morbidity after major and major plus operations (O:E (observed/expected) ratio 0.98 and AUC 0.901) than after minor and moderate operations (O:E ratio 1.13 and AUC 0.759). Conclusions POSSUM, P-POSSUM and E-PASS scores effectively predict morbidity and mortality in surgical treatment of hilar cholangiocarcinoma. However, improvements are still needed in the future because none of these scoring systems yielded an AUC value exceeding 0.9 for operations with all different levels of severity. Only POSSUM had more accuracy in predicting postoperative morbidity after operations with higher severity. Trial registration This study was undertaken after obtaining approval from the ethics committee of School of Medicine, Shanghai Jiao Tong University with a trial registration number of http://09411960800.
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Affiliation(s)
| | | | | | | | | | - Jian Wang
- Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 S, Dongfang Road, Shanghai 200127, China.
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Young JA, Shimi SM, Kerr L, McPhillips G, Thompson AM. Reduction in gastric cancer surgical mortality over 10 years: An adverse events analysis. Ann Med Surg (Lond) 2014; 3:26-30. [PMID: 25568781 PMCID: PMC4268482 DOI: 10.1016/j.amsu.2014.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/25/2014] [Accepted: 03/03/2014] [Indexed: 12/15/2022] Open
Abstract
Background The reduction in gastric cancer mortality is due to a reduction in incidence and of surgical mortality. This study was to examine adverse events in patients with gastric cancer dying under surgical care. Methods Adverse events in surgical care were prospectively audited in patients who died of gastric cancer in Scottish hospitals. A cohort retrospective study examining deaths and contributing adverse events was compared for the periods 1996–2000 and 2001–2005. Results Between 1996 and 2005, 1083 patients with gastric cancer died on surgical wards in Scottish hospitals. The annual number of deaths under surgical care fell significantly from an average of 128 deaths per annum in years 1996–2000 to 88 deaths per annum in 2001–2005 (p < 0.001). This occurred in parallel with the decline in gastric cancer incidence over the same period. There was an increase in the proportion of gastric cancer resections carried out in 7 major hospitals in Scotland in the second period of the study (p < 0.001). The mean number of deaths in the group of patients, who had gastric cancer resection and palliative surgery, were significantly lower in the second period of the study In addition, when all patients were considered as a group, the mean number of anaesthetic, critical care, medical management and technical surgery adverse events were significantly lower in the second study period. Conclusion There has been a reduction in deaths and adverse events for patients with gastric cancer under surgical care and this has been associated with surgical subspecialisation in oesophago-gastric cancer surgery.
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Affiliation(s)
- J A Young
- Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom
| | - S M Shimi
- Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom
| | - L Kerr
- Scottish Audit of Surgical Mortality, Cirrus Building, Marchburn Drive, Paisley PA3 2SJ, United Kingdom
| | - G McPhillips
- Scottish Audit of Surgical Mortality, Cirrus Building, Marchburn Drive, Paisley PA3 2SJ, United Kingdom
| | - A M Thompson
- Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom ; Scottish Audit of Surgical Mortality, Cirrus Building, Marchburn Drive, Paisley PA3 2SJ, United Kingdom
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Chen T, Wang H, Wang H, Song Y, Li X, Wang J. POSSUM and P-POSSUM as predictors of postoperative morbidity and mortality in patients undergoing hepato-biliary-pancreatic surgery: a meta-analysis. Ann Surg Oncol 2013; 20:2501-10. [PMID: 23435569 DOI: 10.1245/s10434-013-2893-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) models are used extensively to predict postoperative morbidity and mortality in general surgery. The aim was to undertake the first meta-analysis of the predictive value of these models in patients undergoing hepato-biliary-pancreatic surgery. METHODS Eligible articles were identified by searches of electronic databases from 1991 to 2012. All data were specific to hepato-biliary-pancreatic surgery. Predictive value of morbidity and mortality were assessed by calculating weighted observed to expected (O/E) ratios. Subanalysis was also performed. RESULTS Sixteen studies were included in final review. The morbidity analysis included nine studies on POSSUM with a weighted O/E ratio of 0.78 [95 % confidence interval (CI) 0.68-0.88]. The mortality analysis included seven studies on POSSUM and nine studies on P-POSSUM (Portsmouth predictor equation for mortality). Weighted O/E ratios for mortality were 0.35 (95 % CI 0.17-0.54) for POSSUM and 0.95 (95 % CI 0.65-1.25) for P-POSSUM. POSSUM had more accuracy to predict morbidity after pancreatic surgery (O/E ratio 0.82; 95 % CI 0.72-0.92) than after hepatobiliary surgery (O/E ratio 0.66; 95 % CI 0.57-0.74), in large sample size studies (O/E ratio 0.90; 95 % CI 0.85-0.96) than in small sample size studies (O/E ratio 0.69; 95 % CI 0.59-0.79). CONCLUSIONS POSSUM overpredicted postoperative morbidity after hepato-biliary-pancreatic surgery. Predictive value of POSSUM to morbidity was affected by the type of surgery and the sample size of studies. Compared with POSSUM, P-POSSUM was more accurate for predicting postoperative mortality. Modifications to POSSUM and P-POSSUM are needed for audit in hepato-biliary-pancreatic surgery.
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Affiliation(s)
- Tao Chen
- Department of General Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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A systematic review of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity and its Portsmouth modification as predictors of post-operative morbidity and mortality in patients undergoing pancreatic surgery. Am J Surg 2013; 205:466-72. [PMID: 23395580 DOI: 10.1016/j.amjsurg.2012.06.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 05/20/2012] [Accepted: 06/08/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) model and its Portsmouth modification (P-POSSUM) are used extensively to predict postoperative mortality and morbidity in general surgery. The aim of this study was to undertake the first systematic review of the predictive value of these models in patients undergoing pancreatic surgery. METHODS Eligible articles were identified by searches of electronic databases for those published from 1991 to 2012. Two independent reviewers assessed each study against inclusion and exclusion criteria. All data were specific to pancreatic surgery. Predictive value of morbidity and mortality were assessed by calculating observed/expected ratios. RESULTS Nine studies were included in the final review. The morbidity analysis included 8 studies (1,734 patients) of POSSUM with a weighted observed/expected ratio of .85. The mortality analysis included 5 studies (936 patients) of POSSUM and 4 studies (716 patients) of P-POSSUM. Weighted observed/expected ratios for mortality were .35 for POSSUM and 1.39 for P-POSSUM. CONCLUSIONS POSSUM overpredicted postoperative morbidity in patients undergoing pancreatic surgery. Both POSSUM and P-POSSUM failed to offer significant predictive value for mortality in pancreatic surgery, and more data collection in large populations undergoing pancreatic surgery are needed.
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Valentí V, Hernández-Lizoain JL, Marínez-Regueira F, Bellver M, Rodríguez J, Díaz González JA, Torres W, Sola JJ, Alvarez-Cienfuegos J. Transthoracic oesophagectomy with lymphadenectomy in 100 oesophageal cancer patients: multidisciplinary approach. Clin Transl Oncol 2012; 13:899-903. [PMID: 22126734 DOI: 10.1007/s12094-011-0752-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Analysis of the results on the treatment of esophageal cancer by transthoracic esophagectomy by a multidisciplinary team of surgeons and oncologists. METHODS Between January 1990 and December 2009, 100 consecutive patients underwent transthoracic esophagectomy. Data were collected prospectively and clinical, pathological and histological features of the tumors were analyzed as well as the results of postoperative morbidity and mortality. RESULTS The average patient age was 55 years (range 31- 83 years). In 59 cases the tumor was located in the lower third and in 41 cases in the middle third. Forty-six patients had adenocarcinoma and 54 squamous cell carcinoma. In 54 cases radio-chemotherapy was planned preoperatively. Classifi cation according to pathological tumor stage was: stage 0 in 21 patients, stage I in 10 patients, stage IIa in 28, stage IIb in 9, stage III in 21 and stage IV in 11. The mean number of lymph nodes examined was 14 (range 0-28). Hospital mortality occurred in 4 cases and postoperative complications in 29 patients (33%). The most frequent postoperative complication was pulmonary complications in 17 cases. The average hospital stay was 15.2 days (range 10-40 days) CONCLUSIONS The results of esophageal cancer have been improved in recent years due to the formation of multidisciplinary teams in this pathology. In our study we have shown that the results obtained with the transthoracic technique for cancer of the esophagus are within the ranges reported in the literature for teams with high prevalence of the disease.
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Affiliation(s)
- V Valentí
- General Surgery Department, Clínica Universidad de Navarra, University of Navarre, Pamplona, Spain.
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Application of Variable Life Adjusted Display (VLAD) to Risk-Adjusted Mortality of Esophagogastric Cancer Surgery. World J Surg 2011; 36:104-8. [DOI: 10.1007/s00268-011-1303-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Dutta S, Al-Mrabt NM, Fullarton GM, Horgan PG, McMillan DC. A comparison of POSSUM and GPS models in the prediction of post-operative outcome in patients undergoing oesophago-gastric cancer resection. Ann Surg Oncol 2011; 18:2808-17. [PMID: 21431986 DOI: 10.1245/s10434-011-1676-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is some evidence that a patient's pre-operative condition influences short-term and long-term post-operative outcomes. The aim of the present study is to compare the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and modified Glasgow prognostic score (mGPS) models in the prediction of post-operative outcome, both short term and long term, in patients undergoing resection of oesophago-gastric cancer. PATIENTS AND METHODS Patients who underwent curative resection for oesophago-gastric cancer from January 2005 to May 2009 and who had data to score the POSSUM, P-POSSUM, O-POSSUM and mGPS models were included in the study. Observed morbidity and mortality rates were compared with predicted outcome in different risk groups. Both short-term outcome and long-term survival were recorded. RESULTS Observed morbidity was 49%, whereas POSSUM predicted post-operative morbidity in 60%, giving an overall standardised morbidity ratio of 0.82. Only male sex [hazard ratio (HR) 3.61, 95% confidence interval (CI) 1.38-9.46, P = 0.009] and POSSUM physiology score (HR 2.13, 95% CI 1.11-4.08, P = 0.023) were independently associated with post-operative morbidity. The post-operative mortality rates predicted by POSSUM, P-POSSUM and O-POSSUM were 16.5, 5.8 and 9.9%, respectively, giving a standardised mortality ratio of 0.25, 0.71 and 0.42. Only mGPS (HR 1.96, 95% CI 1.09-3.54, P = 0.025) and tumour-node-metastasis (TNM) stage (HR 2.21, 95% CI 1.44-3.38, P < 0.001) were independently associated with cancer-specific survival. CONCLUSIONS The POSSUM physiology score was useful in predicting post-operative morbidity, and the mGPS was useful in predicting cancer-specific survival, in patients undergoing surgery for oesophago-gastric cancer.
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Affiliation(s)
- Sumanta Dutta
- University Department of Surgery, Faculty of Medicine, University of Glasgow, Royal Infirmary, Glasgow, UK.
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