A novel simplified scoring system for predicting mortality in emergency colorectal surgery: prediction model development

Abstract

Despite advances in surgical approaches, emergency colorectal surgery has high mortality and morbidity. 1 The mortality rates after emergency colorectal surgery range from 2.3% to 80%. 2,3 This wide range is secondary to the expertise of the surgical center and the patients' comorbidities. Colorectal emergency situations such as diverticulitis, trauma and ischemia may be related to either benign or malignant etiologies. 3 Colorectal cancer is the reason behind colorectal emergencies in 85% of the cases, with colonic obstruction in 11%-43% of all presentations. 4 Perforation and obstruction of the colon and rectum are important factors leading to postoperative mortality in patients with emergency admissions. 5 The comorbidities that cannot be managed adequately in emergency colorectal surgery and which cause highest mortality are cardiopulmonary, renal and thromboembolic diseases. 6 Scoring systems for use in predicting postoperative mortality after surgical procedures already exist. The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and the Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (p-POSSUM) are two examples of such scoring systems. Both of these use physiological and operative parameters. 7 Through use of these systems, it was realized that advanced age and high frequency of emergency procedures within colorectal surgery made these two scores inadequate. Thus, after omission of certain parameters, a new model was devised for colorectal surgery, which was named the colorectal-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (cr-POSSUM).

Risk factors associated with morbidity and mortality in emergency colorectal cancer resections

“…Another study reports compatible results (22). Despite these results, we should keep in mind the possibility of inter-observer variability while talking about ASA scores and giving place in clinical judgment (23). On the other hand, in terms of preexisting comorbidities, COPD was associated with mortality in univariate analysis, but that relationship was not supported in multivariate analysis in our study.…”

“…While our power and time are limited, we want to get to know the patient in the most accurate way with the least variable. And the quest for the best continues (23). The learnings in seeking the best offer the opportunity to guide surgical training and assess the quality of surgical care.…”

Risk calculator score in colorectal surgery: which model?

“…The authors found that major complications were reported in patients who underwent PR operations compared to the AC procedure. Although NSQIP was used for CRS, numerous critical variables were missing from this procedure which include crucial oncologic data pertaining to colorectal cancer [6].…”