Evaluation of the P−POSSUM mortality prediction algorithm in Australian surgical intensive care unit patients

Organ, Nicole; Morgan, Thomas J.; Venkatesh, Balasubramanian; Purdie, David M.

doi:10.1046/j.1445-2197.2002.02528.x

Cited by 13 publications

(10 citation statements)

References 14 publications

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“…An O:E ratio of 0.63 was obtained. Similar findings were obtained by Nicole Organ et al [23] 2002, Australia (0.561), Cheing et al [21] 2007, Malaysia (0.603, emergency laparotomy), Mohil et al [24] 2004, India (0.82). Hence POSSUM was able to accurately predict the adverse outcome following midline emergency laparotomy in our study.…”

Section: Discussionsupporting

confidence: 83%

Evaluation of POSSUM Score for Outcome Prediction in Patients Undergoing Emergency Laparotomy

Rana¹,

Singh²,

Gupta³

et al. 2018

AIMDR

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Background: Emergency Laparotomy is one of the most common surgical procedures performed in Surgical Emergencies, which leads to significant mortality and morbidity. The aim of this study was to evaluate the patients undergoing emergency midline laparotomy, utilizing POSSUM scoring system to help to predict morbidity and mortality in patients, and assuring improved management in present setup. Methods: Total 104 consecutive patients underwent emergency midline laparotomy over a period of two years were included in this prospective study. Surgical outcome was assessed and compared with POSSUM scoring system. The relevant data was recorded on predesigned proforma and analysed. Results: We studied 104 emergency midline laparotomy patients, which resulted in 15 deaths (14.4% Mortality rate). On applying POSSUM, we found that the expected number of deaths for our study group was 24 (O: E= 0.63), relationship was statistically significant. Observed morbidity was 61 (58.65%). On applying POSSUM we found that the expected number of morbidity for our study group was 65 (O: E= 0.93), relationship was statistically significant. Conclusion:The present study validates that the POSSUM is an accurate scoring system for predicting postoperative adverse outcome among patients undergoing major general surgeries in present setup.

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Section: Discussionsupporting

confidence: 83%

Evaluation of POSSUM Score for Outcome Prediction in Patients Undergoing Emergency Laparotomy

Rana¹,

Singh²,

Gupta³

et al. 2018

AIMDR

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“…In a report from Auckland, the P-POSSUM score adequately predicted mortality following major colorectal surgery with the receiver operating characteristic generating an AUC of 0.79 9 . This was superior to the AUC of 0.68 reported for the P-POSSUM prediction of mortality in patients admitted to ICU following mainly general, vascular and ear, nose and throat/ plastics surgical procedures 6 . The present study showed a better performance of P-POSSUM in patients admitted following surgery for upper gastrointestinal malignancies with an AUC of 0.87.…”

Section: Discussioncontrasting

confidence: 69%

Does Adding ICU Data to the POSSUM Score Improve the Prediction of Outcomes following Surgery for Upper Gastrointestinal Malignancies?

Butterfield

Stedman²,

Herod

et al. 2015

Anaesth Intensive Care

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Surgery for upper gastrointestinal malignancy carries a high postoperative mortality and morbidity risk. The importance of preoperative physiological reserve and intraoperative events in determining clinical outcomes is recognised in the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) score that comprises variables relevant to both phases. Whether adding variables linked to ICU admission characteristics improves the predictive capacity of POSSUM is unclear, especially in an Australian/New Zealand healthcare context. This study aimed to evaluate the predictive capacity of the POSSUM score for 30-day mortality and in-hospital morbidity in 80 patients undergoing resection of oesophageal (28%), gastric (26%) or pancreatic (46%) malignancies and admitted to ICU. The 30-day mortality was 8.8% and 65% of patients developed some postoperative complication. Receiver operating characteristics generated an area under the curve (95% CI) to predict mortality by Portsmouth POSSUM of 0.87 (0.77 to 0.93) and morbidity by POSSUM of 0.67 (0.55 to 0.77). Multiple regression analysis including biochemical variables and vital signs on admission to ICU identified renal function parameters, fluid balance and need for cardiorespiratory support beyond the first postoperative day as independent factors associated with mortality and morbidity (in addition to the POSSUM score) but the inclusion of these variables in a logistic regression model did not significantly improve the predictive capacity for mortality (to area under the curve 0.93 [0.85 to 0.97]) or morbidity (to area under the curve 0.67 [0.55 to 0.78]). In conclusion, the POSSUM score provides clinically useful predictive capacity in patients undergoing surgery for upper gastrointestinal malignancies. The incorporation of ICU admission variables to the pre-and intraoperative POSSUM variables did not significantly enhance the precision.

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“…17,35 After recognition that the POSSUM model overpredicted adverse outcome, the Portsmouth variation (P-POSSUM) was developed to predict mortality, using the same composite variables but a different calculation. 36 P-POSSUM has been used in a larger number of more recent studies [28][29][30]32,37 than the original POSSUM 25,29,30 and has been found to be of moderate to high discriminant accuracy (AUROC varying between 0.68 and 0.92) with the exception of one Australian study. 37…”

Section: Risk Stratification Tools Incorporating Intra-and Postoperatmentioning

confidence: 99%

Risk Stratification Tools for Predicting Morbidity and Mortality in Adult Patients Undergoing Major Surgery

et al. 2013

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Risk stratification is essential for both clinical risk prediction and comparative audit. There are a variety of risk stratification tools available for use in major noncardiac surgery, but their discrimination and calibration have not previously been systematically reviewed in heterogeneous patient cohorts.Embase, MEDLINE, and Web of Science were searched for studies published between January 1, 1980 and August 6, 2011 in adult patients undergoing major noncardiac, nonneurological surgery. Twenty-seven studies evaluating 34 risk stratification tools were identified which met inclusion criteria. The Portsmouth-Physiology and Operative Severity Score for the enUmeration of Mortality and the Surgical Risk Scale were demonstrated to be the most consistently accurate tools that have been validated in multiple studies; however, both have limitations. Future work should focus on further evaluation of these and other parsimonious risk predictors, including validation in international cohorts. There is also a need for studies examining the impact that the use of these tools has on clinical decision making and patient outcome.

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Evaluation of the P−POSSUM mortality prediction algorithm in Australian surgical intensive care unit patients

Abstract: The P-POSSUM algorithm tends to over-estimate mortality in surgical intensive care patients. It may require further calibration before adoption as a surgical audit tool in Australia.

Cited by 13 publications

References 14 publications

Evaluation of POSSUM Score for Outcome Prediction in Patients Undergoing Emergency Laparotomy

Evaluation of POSSUM Score for Outcome Prediction in Patients Undergoing Emergency Laparotomy

Does Adding ICU Data to the POSSUM Score Improve the Prediction of Outcomes following Surgery for Upper Gastrointestinal Malignancies?

Risk Stratification Tools for Predicting Morbidity and Mortality in Adult Patients Undergoing Major Surgery

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