What question did this study set out to answer?

To develop a dedicated Colorectal POSSUM (CR-POSSUM) equation for predicting operative mortality and compare its predictive performance with the Portsmouth POSSUM (P-POSSUM) model.

July 26, 2004British journal of surgeryOpen Access

Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM)

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Why the study?

Does the CR-POSSUM model accurately predict operative mortality in patients undergoing colorectal surgery compared to the P-POSSUM model?

Population

6,790 patients undergoing colorectal surgery in 15 UK hospitals

Comparison

CR-POSSUM model vs Portsmouth-POSSUM model and age-adjusted POSSUM…

Design

Cohort

Authors

PTParis TekkisGlan Clwyd Hospital DPDavid PrytherchUniversity of Portsmouth HKHemant M. KocherQueen Mary University of London

Discussion

Member takes

Implication

CR-POSSUM calibration supports its consideration for colorectal mortality prediction; leaves open need for prospective validation before routine use.

Key Points

To develop a dedicated Colorectal POSSUM (CR-POSSUM) equation for predicting operative mortality and compare its predictive performance with the Portsmouth POSSUM (P-POSSUM) model.
Prospective data were collected from 6883 patients undergoing elective (68.2%) or emergency (31.0%) colorectal surgery across 15 UK hospitals between 1993 and 2001.
Stepwise logistic regression was performed using a 60:40 percent split-sample validation approach to develop and test an age-adjusted POSSUM model and the CR-POSSUM model.
Operative mortality across the cohort was 5.7% (387 of 6790 patients), occurring in 2.8% of elective operations and 12.0% of emergency operations.
CR-POSSUM, age-adjusted POSSUM, and P-POSSUM exhibited similar areas under the receiver-operator characteristic curves.
Model calibration was superior for CR-POSSUM and age-adjusted POSSUM compared to P-POSSUM, yielding observed-to-expected mortality ratios of 1.000, 0.998, and 0.911, respectively, in the test population.

Structured PICO

Does the CR-POSSUM model accurately predict operative mortality in patients undergoing colorectal surgery compared to the P-POSSUM model?

Population

6,790 patients undergoing colorectal surgery (4,632 elective, 2,107 emergency; 2,437 malignant, 4,267 non-malignant diseases) in 15 UK hospitals

Intervention

CR-POSSUM model (dedicated colorectal Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity)

Comparator

Portsmouth (P)-POSSUM model and age-adjusted POSSUM model

Outcome

Operative mortalityhard clinical

The CR-POSSUM model provides an accurate, dedicated risk-adjustment scoring system for predicting operative mortality in colorectal surgery.

Limitations

External validation is required in hospitals different from those in which the model was developed.

Cite This Study

Tekkis et al. (2004) studied this question.

synapsesocial.com/papers/6a716f8efebe604dd70a1b1a https://doi.org/10.1002/bjs.4430

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Implication

CR-POSSUM calibration supports its consideration for colorectal mortality prediction; leaves open need for prospective validation before routine use.