The Analysis of Scoring Systems Predicting Mortality in Geriatric Emergency Abdominal Surgery

Ozban, Murat; Birsen, Onur; Uzel Senel, M.; Kabay, Burhan

doi:10.5505/tjtes.2015.05046

Cited by 12 publications

(11 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, there seems to be no consensus as to the reliability of this score in predicting mortality in clinical practice. While several studies have shown that P-POSSUM is an accurate indicator of mortality (Gonzalez-Martinez et al 2016, Hayes et al 2016, Igari et al 2013, Tyagi et al 2017), it has also been seen that it can over predict mortality (Ozban et al 2015, Stonelake et al 2015). There have been multiple studies exploring the effectiveness of P-POSSUM in determining mortality risk in general surgical patients with a particular focus in evaluating the risk in the elderly population.…”

Section: Discussionmentioning

confidence: 99%

Mortality risk scoring in emergency general surgery: Are we using the best tool?

Thahir

Pinto-Lopes

Madenlidou

et al. 2020

Journal of Perioperative Practice

View full text Add to dashboard Cite

Background It is imperative that an accurate assessment of risk of death is undertaken preoperatively on all patients undergoing an emergency laparotomy. Portsmouth-Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) is one of the most widely used scores. National Emergency Laparotomy Audit (NELA) presents a novel, validated score, but no direct comparison with P-POSSUM exists. We aimed to determine which would be the best predictor of mortality. Methods We analysed all the entries on the online NELA database over a four-and-a-half-year period. The Hosmer–Lemeshow goodness of fit test was performed to assess model calibration. For the outcome of death and for each scoring system, a non-parametric receiver operator characteristic analysis was done. The sensitivity, specificity, area under receiver operator characteristic curve and their standard errors were calculated. Results Data pertaining to 650 patients were included. There were 59 deaths, giving an overall observed mortality rate of 9.1%. Predicted mortality rate for the P-POSSUM score and NELA score were 15.2% and 7.8%, respectively. The discriminative power for mortality was highest for the NELA score (C-index = 0.818, CI: 0.769–0.867, p < 0.001), when compared to P-POSSUM (C-index = 0.769, CI: 0.712–0.827, p < 0.001). Conclusions The NELA score showed good discrimination in predicting mortality in the entire cohort. The P-POSSUM over-predicted observed mortality and the NELA score under-predicted observed mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Mortality risk scoring in emergency general surgery: Are we using the best tool?

Thahir

Pinto-Lopes

Madenlidou

et al. 2020

Journal of Perioperative Practice

View full text Add to dashboard Cite

show abstract

“…Among these are recent studies that compared a number of available frailty scores. In one study, the diagnostic accuracy of six screening instruments for frailty was evaluated.…”

Section: Screening and Assessment Of Frailtymentioning

confidence: 99%

“…A second study used scoring systems developed for intensive care medicine and elective surgery, and analysed whether they could predict mortality in the frail elderly patient needing emergency surgery. The scoring systems varied in terms of sensitivity and estimated mortality, but the Acute Physiology And Chronic Health Evaluation (APACHE) II system had a sensitivity of 96 per cent in estimating postoperative mortality.…”

Section: Screening and Assessment Of Frailtymentioning

confidence: 99%

Emergency general surgery in the geriatric patient

Desserud

Veen

Søreide

2015

British Journal of Surgery

144

View full text Add to dashboard Cite

Background: Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care.Methods: This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. Results:The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care.Conclusion: Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited.

show abstract

“…In our study the higher risk groups were predicted better with lower risk groups having overprediction. Ozman M et al 10 in their study concluded that POSSUM scoring obtained from a heterogeneous population was a successful audit tool, but in low risk groups, it overestimated the mortality rate. Moreover they reported that predictive value of POSSUM for morbidity was affected by the type of surgery and the sample size of the study.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of POSSUM Scoring System in Predicting Mortality and Morbidity in Patients of Perforative Peritonitis

L¹,

Rina²,

Nongmaithem³

et al. 2020

jebmh

View full text Add to dashboard Cite

BACKGROUND Peritonitis developing as a result of hollow viscus perforation is a common condition in a developing country like India. Even if the patient reaches the hospital in time and is operated, the postoperative period is still unpredictable. Secondary peritonitis is the consequence of contamination of the peritoneal cavity due to contents of a hollow viscus within the peritoneal cavity. As peritonitis following hollow viscus perforation is a life threatening condition commonly encountered in our hospital, a uniform scoring system is good to judge the efficacy of the health care as well for prognostic purposes. It helps in selecting patients at high risk who may require intensive management. Thus there has been a search for accurate risk scoring system that can be used to compare patient's outcome. POSSUM scoring system with its 12 physiological score and 6 operative score was used to predict the expected morbidity and mortality. METHODS: The present study was a cross sectional study where cases diagnosed as perforative peritonitis undergoing laparotomy in the Department of Surgery, RIMS, Imphal, Manipur, India were studied. RESULTS Out of the 100 patients in the study, 5 died and 28 had some form of morbidity. There were no patients with predicted morbidity score of less than 25. The minimum score is 6 and maximum is 48. CONCLUSIONS POSSUM scoring is a good tool to predict morbidity and mortality in patients undergoing laparotomy following hollow viscus perforation provided risk stratification is done.

show abstract

The Analysis of Scoring Systems Predicting Mortality in Geriatric Emergency Abdominal Surgery

Cited by 12 publications

References 13 publications

Mortality risk scoring in emergency general surgery: Are we using the best tool?

Mortality risk scoring in emergency general surgery: Are we using the best tool?

Emergency general surgery in the geriatric patient

Accuracy of POSSUM Scoring System in Predicting Mortality and Morbidity in Patients of Perforative Peritonitis

Contact Info

Product

Resources

About