Sistema POSSUM. Un instrumento de medida de la calidad en el paciente quirúrgico

Campillo-Soto, Álvaro; Flores-Pastor, Benito; Soria-Aledo, Víctor; Candel-Arenas, Marife; Andrés-García, Bruno; Martín-Lorenzo, Juan Gervasio; Aguayo-Albasini, José Luís

doi:10.1016/s0009-739x(06)70993-9

Cited by 21 publications

(12 citation statements)

References 17 publications

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“…P-POSSUM predicts mortality equally well. Both can be used for risk-adjusted surgical audit [ 57 ] 2005 High risk patients undergoing surgery p-POSSUM predicted mortality well but POSSUM over-predicted mortality [ 58 ] 2006 elective and emergency laparotomy It is a useful predictor of morbidity and mortality [ 59 ] 2007 General surgery M-POSSUM correlates better with postoperative complications and mortality than POSSUM [ 60 ] 2008 cases of ileal perforations Significant correlation between POSSUM score and postoperative complications and deaths [ 61 ] 2009 Patients undergoing emergency laparotomy P-POSSUM predicts mortality better than POSSUM. Exponential method is better than linear regression analysis [ 62 ] 2009 Unresectable pancreatic cancer during exploratory laparotomy POSSUM scoring system is an independent predictor of survival in multivariate analysis [ 63 ] 2009 oncologic gastric surgery Mortality lower than that predicted by POSSUM and higher than that predicted by P-POSSUM [ 64 ] 2010 patients undergoing emergency surgery ASA grade and POSSUM scores were the better predictors of mortality than EWS, APACHE II, and age [ 65 ].…”

Section: Surgical Audit Scoring Systemsmentioning

confidence: 99%

Assessing the risk: Scoring systems for outcome prediction in emergency laparotomies

Nag¹

2015

BioMed

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Emergency laparotomy is the commonest emergency surgical procedure in most hospitals and includes over 400 diverse surgical procedures. Despite the evolution of medicine and surgical practices, the mortality in patients needing emergency laparotomy remains abnormally high. Although surgical risk assessment first started with the ASA Physical Status score in 1941, efforts to find an ideal scoring system that accurately estimates the risk of mortality, continues till today. While many scoring systems have been developed, no single scoring system has been validated across multiple centers and geographical locations. While some scoring systems can predict the risk merely based upon preoperative findings and parameters, some rely on intra-operative assessment and histopathology reports to accurately stratify the risk of mortality. Although most scoring systems can potentially be used to compare risk-adjusted mortality across hospitals and amongst surgeons, only those which are based on preoperative findings can be used for risk prognostication and identify high-risk patients before surgery for an aggressive treatment. The recognition of the fact, that in the absence of outcome data in these patients, it would be impossible to evaluate the impact of quality improvement initiatives on risk-adjusted mortality, hospital groups and surgical societies have got together and started to pool data and analyze it. Appropriate scoring systems for emergency laparotomies would help in risk prognostication, risk-adjusted audit and assess the impact of quality improvement initiative in patient care across hospitals. Large multi-centric studies across varied geographic locations and surgical practices need to assess and validate the ideal and most apt scoring system for emergency laparotomies. While APACHE-II and P-POSSUM continue to be the most commonly used scoring system in emergency laparotomies,studies need to compare them in their ability to predict mortality and explore if either has a higher sensitivity and specificity than the other.

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Section: Surgical Audit Scoring Systemsmentioning

confidence: 99%

Assessing the risk: Scoring systems for outcome prediction in emergency laparotomies

Nag¹

2015

BioMed

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“…We used the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) risk assessment methods to calculate the rates of postoperative complications and mortality, and postoperative mortality rate, respectively. 2,3 The POSSUM scoring system was established by Copeland et al in 1991, 4 who used the preoperative physiological scores and intraoperative surgical scores of patients to predict the rates postoperative complications and mortality among patients, in order to assess the risk of surgery. In 1996, Whiteley et al 5 found that POSSUM overestimated the postoperative mortality rate, and they revised the statistical regression equation, which was referred to as P-POSSUM.…”

Section: Introductionmentioning

confidence: 99%

<p>Application of POSSUM and P-POSSUM in Surgical Risk Assessment of Elderly Patients Undergoing Hepatobiliary and Pancreatic Surgery</p>

Ruiqiang

Xia

et al. 2020

CIA

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Purpose To investigate the efficacy and accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) scoring systems in the risk assessment of postoperative complications and death in elderly patients undergoing hepatobiliary and pancreatic surgery. Patients and Methods Using POSSUM and P-POSSUM, 274 elderly patients undergoing hepatobiliary and pancreatic surgery were evaluated, and the complications and deaths predicted by the systems were compared with the actual situation. The accuracy and predictive ability of POSSUM and P-POSSUM were evaluated using chi-squared and t -tests, consistency of predicted and actual complication rates (observed/expected, OE ratio), and receiver operating characteristic (ROC) curve. Results The complication rate predicted by POSSUM (R1) was 22.57%, while the actual postoperative complication rate was 17.88% (P>0.05). The mortality rate predicted by POSSUM (R2) was 4.61%, while the actual rate was 1.09% (P<0.05). The mortality rate predicted by P-POSSUM (R) was 1.42%, while the actual rate was 1.09% (P>0.05). Patients with complications had higher physiology scores (PS), operative severity scores (OS), and POSSUM scores than those without complications (P<0.05). Furthermore, PS, OS, and POSSUM scores were higher in the mortality group than in the survival group. However, the number of individuals in the mortality group was too small to accurately reflect the overall situation. Stratified analysis showed that consistency of the OE ratio in different subgroups was close to 1. The ROC curve showed that the area under the curve for the complication rate predicted by POSSUM was 0.76. Conclusion Although the postoperative mortality rate was higher than the actual value, POSSUM could accurately predict the postoperative complication rate in elderly patients undergoing hepatobiliary and pancreatic surgery. The P-POSSUM accurately predicted the postoperative mortality rate in this population. Patients with complications had higher POSSUM scores.

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“…Las desventajas de este sistema de puntuación son la falta de información respecto al procedimiento quirúrgico y la subjetividad de la evaluación de la comorbilidad de los pacientes [228]. Para calcular el riesgo perioperatorio, la suma de las variables fisiológicas y quirúrgicas se introducen en dos ecuaciones matemáticas que se utilizan para calcular el riesgo de morbimortalidad [224].…”

Section: Complicaciones De La Prostatectomía Radicalunclassified

“…Estas últimas se pueden subdividir en las que estén diseñadas para predecir la morbilidad y la mortalidad cardíaca, como el índice de riesgo cardiaco revisado (RCRI) de Lee y las que predicen la morbilidad y mortalidad de forma genérica. Estas incluyen las escalas que utilizan exclusivamente factores de riesgo preoperatorios, como el índice de Charlson y las que buscan combinaciones de factores pre, intra y postoperatorios como la escala de severidad fisiológica y operatoria para la evaluación de la morbimortalidad (POSSUM)[224].Riesgo en la población: Escala de riesgo de la ASA La escala de riesgo de la ASA utiliza el estado físico preoperatorio para estratificar a los pacientes subjetivamente en cinco subgrupos. Se diseñó en 1 1 y en 1 6 se describió la escala de cinco puntos más conocida en la actualidad existe una categoría adicional para los pacientes donantes de órganos Tabla 4.…”

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“…Después de 12 meses, la estimación también favorece a la PRR (RR 1,06, IC 95%: 1,02 a 1,10).-Por último, la PRR se asoció con una mayor probabilidad de conservación de la función sexual después de 12 meses, en comparación con el PRA (RR 1,55, IC 95%: 1,20 a 1,99).Si comparamos las técnicas robótica y laparoscópica en la bibliografía[198,383]:-En relación a la tasa de márgenes positivos, la comparación entre la PRR y la PRL en pacientes pT2 muestra resultados no concluyentes (RR 0,82, IC 95%: 0,52 a 1,29), al igual que en los pacientes con un pT3 (RR 0,91, IC 95% 0,6 a 1,46).-Los resultados de continencia urinaria a los de tres meses (RR 1,10, IC 95%: 0,90 a 1,34) y, después de 12 meses (RR 1,08, IC 95% 0,99 a 1,18), no parecen concluyentes en la comparación entre ambas técnicas.En nuestro estudio:-sólo hemos podido encontrar un estadío tumoral más avanzado en los pacientes que reciben analgesia epidural postquirúrgica. (p:0.0420).-Se constataron más complicaciones postquirúrgicas que precisaron atención urgente en los pacientes que reciben analgesia epidural postquirúrgica (p=0.002) (23% frente a 2%), pero tales complicaciones no están directamente relacionadas con la anestesia (salvo la RAO que es la única que podría tener sentido), sino224 con el tipo de técnica quirúrgica, pues fueron del tipo seroma, infección, dehiscencia de herida quirúrgica, ITU, RAO, fístula, disfunción eréctil. Este resultado está muy influido por los siguientes factores:1.…”

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Influencia de la variabilidad en la técnica anestésica y la analgesia en los resultados de la prostatectomía radical

Martin¹,

Cristina²

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Sistema POSSUM. Un instrumento de medida de la calidad en el paciente quirúrgico

Cited by 21 publications

References 17 publications

Assessing the risk: Scoring systems for outcome prediction in emergency laparotomies

Assessing the risk: Scoring systems for outcome prediction in emergency laparotomies

<p>Application of POSSUM and P-POSSUM in Surgical Risk Assessment of Elderly Patients Undergoing Hepatobiliary and Pancreatic Surgery</p>

Influencia de la variabilidad en la técnica anestésica y la analgesia en los resultados de la prostatectomía radical

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