Validity of the CR-POSSUM model in surgery for colorectal cancer in Spain (CCR-CARESS study) and comparison with other models to predict operative mortality

Baré, Marisa; Alcántara, Manuel Jesús; Gil, María José; Collera, P; Pont, Marina; Escobar, Antonio; Sarasqueta, Cristina; Redondo, Maximino; Briones, Eduardo; Dujovne, Paula; Quintana, José M.

doi:10.1186/s12913-018-2839-x

Cited by 16 publications

(17 citation statements)

References 32 publications

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“…POSSUM AND P-POSSUM were original scoring systems which enumerated the mortality and morbidity in a patient undergoing major surgeries [10,11]. These have been validated in numerous studies outside the UK, and their value in surgical audit has been proven beyond doubt [12][13][14]. A study conducted by the American College of Surgeons (ACS-NSQIP) in 2005 to 2006 showed that ten procedure groups among various general surgical operations accounted for 62% of complications, and colectomy was topping in the list [15].…”

Section: Discussionmentioning

confidence: 99%

CR-Possum—Can It Be Used to Predict Morbidity? A Single-Centre Retrospective Study

Prabakaran¹,

Thangaraju²,

Mathew

et al. 2018

Indian J Surg Oncol

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Preoperative prediction of morbidity in colorectal cancer (CRC) surgery helps to optimize the surgical outcome. In this study, we aim to develop a dedicated equation for predicting operative morbidity using colorectal possum scoring system and also to validate the predictive accuracy of CR-POSSUM scoring system in prognosticating actual complications. We did a retrospective analysis of 322 patients undergoing colorectal cancer surgery from a single centre in South India from 2004 to 2016. Mortality and morbidity risk factors as defined by CR POSSUM were collected from 322 patients who underwent CRC surgery and were used to derive equations to predict morbidity, and the results were compared with the observed morbidity. Logistic regression analysis was used to derive the equation. The model fit and model discrimination were analysed using the Hosmer-Lemeshow statistical test for goodness of fit, the Nagelkerke R 2 and area under the receiver operating characteristic (ROC) curve respectively. Out of 322 patients, 103 (32%) patients developed complications and 10 (3%) died due to complications. The regression equation we derived has an overall correct classification of about 70% (P < 0.01) with positive and negative predictive value of 60% and 73% respectively. The Hosmer-Lemeshow goodness of fit was 3.147 (P = 0.829), and the Nagelkerke R 2 was 17% and area under ROC as model discrimination was 71.6%. Hence, CR-POSSUM scoring which was originally used for predicting mortality risk can also be extrapolated to predict morbidity.

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Section: Discussionmentioning

confidence: 99%

CR-Possum—Can It Be Used to Predict Morbidity? A Single-Centre Retrospective Study

Prabakaran¹,

Thangaraju²,

Mathew

et al. 2018

Indian J Surg Oncol

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“…Reasons include the limited discriminatory power of some, the complexity of the calculations required, and the large number of variables that must be taken into account, some of which are not recorded routinely. A recent validation of the POSSUM, Portsmouth (P) POSSUM, colorectal (CR) POSSUM, Identification of Risk in Colorectal Surgery (IRCS) and Association Française de Chirurgie (AFC) models in a multicentre cohort in Spain concluded that none obtained optimal discriminatory power (all had area under the receiver operating characteristic (ROC) curve (AUC) values below 0·70), as also found by others. Some of the variables included in some of these models (such as urea, blood loss or surgical technique) are not available before the intervention, and this limits their utility.…”

Section: Introductionmentioning

confidence: 99%

CCR-CARESS score for predicting operative mortality in patients with colorectal cancer

Baré

Mora

Torà

et al. 2018

British Journal of Surgery

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“…Surgery is essential in many cases of CRC and is associated with considerable mortality (up to 11% at 30 days) and a high rate of complications 6,7. Many factors are associated with outcomes after different types of surgery, and COPD has been associated with increased short-term mortality.…”

Section: Introductionmentioning

confidence: 99%

“…Surgery is essential in many cases of CRC and is associated with considerable mortality (up to 11% at 30 days) and a high rate of complications. 6 , 7 Many factors are associated with outcomes after different types of surgery, and COPD has been associated with increased short-term mortality. However, few studies of postoperative outcomes in patients with COPD focus on patients with CRC or on postoperative outcomes other than mortality, such as reintervention, complications, or length of stay (LOS).…”

Section: Introductionmentioning

confidence: 99%

COPD is a clear risk factor for increased use of resources and adverse outcomes in patients undergoing intervention for colorectal cancer: a nationwide study in Spain

Baré

Montón

Mora

et al. 2017

COPD

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BackgroundWe hypothesized that patients undergoing surgery for colorectal cancer (CRC) with COPD as a comorbidity would consume more resources and have worse in-hospital outcomes than similar patients without COPD. Therefore, we compared different aspects of the care process and short-term outcomes in patients undergoing surgery for CRC, with and without COPD.MethodsThis was a prospective study and it included patients from 22 hospitals located in Spain – 472 patients with COPD and 2,276 patients without COPD undergoing surgery for CRC. Clinical variables, postintervention intensive care unit (ICU) admission, use of invasive mechanical ventilation, and postintervention antibiotic treatment or blood transfusion were compared between the two groups. The reintervention rate, presence and type of complications, length of stay, and in-hospital mortality were also estimated. Hazard ratio (HR) for hospital mortality was estimated by Cox regression models.ResultsCOPD was associated with higher rates of in-hospital complications, ICU admission, antibiotic treatment, reinterventions, and mortality. Moreover, after adjusting for other factors, COPD remained clearly associated with higher and earlier in-hospital mortality.ConclusionTo reduce in-hospital morbidity and mortality in patients undergoing surgery for CRC and with COPD as a comorbidity, several aspects of perioperative management should be optimized and attention should be given to the usual comorbidities in these patients.

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Validity of the CR-POSSUM model in surgery for colorectal cancer in Spain (CCR-CARESS study) and comparison with other models to predict operative mortality

Abstract: Background: To validate and recalibrate the CR-POSSUM model and compared its discriminatory capacity with other European models such as POSSUM, P-POSSUM, AFC or IRCS to predict operative mortality in surgery for colorectal cancer.

Cited by 16 publications

References 32 publications

CR-Possum—Can It Be Used to Predict Morbidity? A Single-Centre Retrospective Study

CR-Possum—Can It Be Used to Predict Morbidity? A Single-Centre Retrospective Study

CCR-CARESS score for predicting operative mortality in patients with colorectal cancer

COPD is a clear risk factor for increased use of resources and adverse outcomes in patients undergoing intervention for colorectal cancer: a nationwide study in Spain

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