Preoperative Risk Assessment: A Poor Predictor of Outcome in Critically ill Elderly with Sepsis After Abdominal Surgery

Cuijpers, Anne C M; Coolsen, Mariëlle M.E.; Schnabel, Ronny M.; Santen, Susanne van; Damink, Steven W. M. Olde; Poll, Marcel C. G. van de

doi:10.1007/s00268-020-05742-5

Cited by 5 publications

(9 citation statements)

References 43 publications

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“…We found in our study that APACHE II is more suitable than the POSSUM score in predicting mortality, similar to some studies’ results [ 16 ]. On the other hand, the ASA classification system was insufficient with 0.63, similar to Cuijpers’ 108-patient series [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Prediction of Mortality in Patients After Oncologic Gastrointestinal Surgery: Comparison of the ASA, APACHE II, and POSSUM Scoring Systems

Kisa¹,

Kisa²,

Çevik³

2021

Cureus

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Scoring systems have been developed to predict the expected mortality and morbidity in surgical procedures. In this study, our aim was to compare the ASA (American Society of Anesthesiologists), APACHE (Acute Physiology and Chronic Health Evaluation) II, POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) scoring systems as predictors of mortality in patients who underwent gastrointestinal oncologic surgery, followed, and were admitted to the intensive care unit during the postoperative period. We examined the files of 82 patients who underwent oncologic gastrointestinal surgery and followed up in the intensive care units (ICUs). The patients' APACHE II scores and predicted mortality rates (PMR) according to the APACHE II, POSSUM, and ASA scores were calculated. The receiver operator characteristic (ROC) curve analysis was used when evaluating the performances of the ASA, APACHE, and POSSUM scoring systems in terms of accurate assessment of mortality. Accordingly, the area under the curve (AUC) = 0.5 no distinction, 0.5

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Section: Discussionmentioning

confidence: 99%

Prediction of Mortality in Patients After Oncologic Gastrointestinal Surgery: Comparison of the ASA, APACHE II, and POSSUM Scoring Systems

Kisa¹,

Kisa²,

Çevik³

2021

Cureus

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“…However, as our results reveal, the POSPOM is not appropriate to be used for the preoperative stratification of scheduled postsurgical ICU allocation. In recent years, a number of studies tried to identify risk factors that allow to predict the need for either scheduled or unplanned postoperative ICU admission and therefore facilitate resource allocation [ 28 – 35 ]. Some studies focus on those variables distinguishing patients admitted to normal ward from those admitted to the ICU, including early or even planned admission based on hospital-specific standard procedures [ 28 , 30 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…In their very recent work, Cuijpers et al drew exactly the same conclusion and state that “ perioperative risk assessment reflecting premorbid physical status […] loses its value when complications occur requiring unplanned ICU admission . Risks […] should be re-assessed based on current clinical condition prior to ICU admission , because outcome prediction is more reliable then .” [ 35 ]. Of course, performing a controlled study (which is usually considered to be the gold standard to determine the benefits of an intervention) and allocating patients to either normal ward or ICU on a random basis would not be possible.…”

Section: Discussionmentioning

confidence: 99%

“…However, other authors compared cohorts of patients admitted to normal ward with unplanned or emergency admittance to ICU [ 33 ] and used propensity score matching [ 29 ] or correlated their results with other already established surgical risk prediction scores such as the Emergency Surgery Score (ESS) [ 34 ]. Moreover, performance of risk prediction tools may also vary depending on patient population or surgical subspecialties [ 28 , 30 , 33 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

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The level of postoperative care influences mortality prediction by the POSPOM score: A retrospective cohort analysis

Menzenbach

Layer

et al. 2021

PLoS ONE

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Background The Preoperative Score to Predict Postoperative Mortality (POSPOM) assesses the patients’ individual risk for postsurgical intrahospital death based on preoperative parameters. We hypothesized that mortality predicted by the POSPOM varies depending on the level of postoperative care. Methods All patients age over 18 years undergoing inpatient surgery or interventions involving anesthesia at a German university hospital between January 2006, and December 2017, were assessed for eligibility for this retrospective study. Endpoint was death in hospital following surgery. Adaptation of the POSPOM to the German coding system was performed as previously described. The whole cohort was divided according to the level of postoperative care (normal ward vs. intensive care unit (ICU) admission within 24 h vs. later than 24 h, respectively). Results 199,258 patients were finally included. Observed intrahospital mortality was 2.0% (4,053 deaths). 9.6% of patients were transferred to ICU following surgery, and mortality of those patients was increased already at low POSPOM values of 15. 17,165 patients were admitted to ICU within 24 h, and these patients were older, had more comorbidities, or underwent more invasive surgery, reflected by a higher median POSPOM score compared to the normal-ward group (29 vs. 17, p <0.001). Mortality in that cohort was significantly increased to 8.7% (p <0.001). 2,043 patients were admitted to ICU later than 24 h following surgery (therefore denoted unscheduled admission), and the median POSPOM value of that group was 23. Observed mortality in this cohort was highest (13.5%, p <0.001 vs. ICU admission <24 h cohort). Conclusion Increased mortality in patients transferred to high-care wards reflects the significance of, e.g., intra- or early postoperative events for the patients’ outcome. Therefore, scoring systems considering only preoperative variables such as the POSPOM reveal limitations to predict the individual benefit of postoperative ICU admission.

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“…Traditional predictors of postoperative complications, such as age, sex and comorbidities are insufficiently accurate in estimating a patient's ability to cope with perioperative stressors. Furthermore, these predictors do not anticipate the impact of surgery and potential complications on the recovery of physical functioning 5 . Several physical fitness‐related variables, especially preoperative aerobic fitness and body composition variables, are gaining interest as modifiable risk factors that better reflect a patient's preoperative reserve capacity.…”

Section: Introductionmentioning

confidence: 99%

Aerobic fitness and muscle density play a vital role in postoperative complications in colorectal cancer surgery

Cuijpers

Bongers

Heldens

et al. 2022

Journal of Surgical Oncology

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Background and Objectives To assess the association of preoperative aerobic fitness and body composition variables with a patient's resilience to the development and impact of postoperative complications after elective colorectal cancer (CRC) surgery. Methods Preoperative aerobic fitness was assessed by steep ramp test performance. Preoperative body composition was assessed by muscle mass and density determined from preoperative computed tomography scan analysis at the L3‐level. Complication development and severity was graded according to Clavien‐Dindo. Complication impact was assessed by the time to recovery of physical functioning after complications. Multivariable logistic regression analyses adjusted for age, sex, comorbidities and tumour location was performed. Results Of 238 included patients, 96 (40.3%) developed postoperative complications. Better preoperative aerobic fitness decreased the likelihood to develop complications, independent of muscle mass (odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.35−0.85) or muscle density (OR: 0.57, 95% CI: 0.36−0.89). A prolonged time to recovery following complications was associated with lower preoperative muscle density (OR: 4.14, 95% CI: 1.28−13.41), independent of aerobic fitness. Conclusions Lower aerobic fitness increases the risk of complication development, while low muscle density seems associated with a prolonged recovery from complications. Aerobic fitness and muscle density could be valuable additives to preoperative risk assessment.

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Preoperative Risk Assessment: A Poor Predictor of Outcome in Critically ill Elderly with Sepsis After Abdominal Surgery

Cited by 5 publications

References 43 publications

Prediction of Mortality in Patients After Oncologic Gastrointestinal Surgery: Comparison of the ASA, APACHE II, and POSSUM Scoring Systems

Prediction of Mortality in Patients After Oncologic Gastrointestinal Surgery: Comparison of the ASA, APACHE II, and POSSUM Scoring Systems

The level of postoperative care influences mortality prediction by the POSPOM score: A retrospective cohort analysis

Aerobic fitness and muscle density play a vital role in postoperative complications in colorectal cancer surgery

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