The multilevel O-POSSUM model provided higher discrimination for predicting postoperative mortality than P-POSSUM (AUC 79.7% vs 74.3%) and better calibration.
Observational (n=1,042)
Does the multilevel O-POSSUM model improve risk-adjusted prediction of postoperative mortality in oesophagogastric surgery compared to P-POSSUM?
The multilevel O-POSSUM model provides more accurate risk-adjusted prediction of postoperative mortality for oesophagogastric surgery compared to the P-POSSUM model.
Absolute Event Rate: 79.7% vs 74.3%
INTRODUCTION: The present study was designed to develop a dedicated oesophagogastric model for the prediction of risk-adjusted postoperative mortality in upper gastrointestinal surgery (O-POSSUM). METHODS: Using 1042 patients undergoing oesophageal (n = 538) or gastric (n = 504) surgery between 1994 and 2000 the Portsmouth predictor equation for mortality (P-POSSUM) scoring system was compared with a standard logistic regression O-POSSUM model and a multilevel O-POSSUM model using the following independent factors: age, physiological status, mode of surgery, type of surgery and histological stage. RESULTS: The overall mortality rate was 12.0 per cent (elective mortality rate 9.4 per cent and emergency mortality rate 26.9 per cent). P-POSSUM overpredicted mortality (14.5 per cent), particularly in the elective group of patients. The multilevel model offered higher discrimination than the single-level O-POSSUM and P-POSSUM models (area under receiver-operator characteristic curve 79.7 versus 74.6 and 74.3 per cent). When observed to expected outcomes were evaluated, the multilevel O-POSSUM model was found to offer better calibration (Hosmer-Lemeshow chi(2) statistic 10.15 versus 10.52 and 28.80). CONCLUSION: The multilevel O-POSSUM model provided an accurate risk-adjusted prediction of death from oesophageal and gastric surgery for individual patients. In conjunction with a multidisciplinary approach to patient management, the model may be used in everyday practice for perioperative counselling of patients and their carers.
Tekkis et al. (Mon,) conducted a observational in Oesophageal or gastric surgery (n=1,042). Multilevel O-POSSUM model vs. P-POSSUM and single-level O-POSSUM models was evaluated on Postoperative mortality prediction (discrimination area under ROC curve). The multilevel O-POSSUM model provided higher discrimination for predicting postoperative mortality than P-POSSUM (AUC 79.7% vs 74.3%) and better calibration.