Key result
The P-POSSUM score accurately predicted overall mortality (expected 5.8% vs. observed 5.6%), whereas the POSSUM score significantly overestimated overall morbidity (expected 39.2% vs. observed 15.6%).
Why the study?
Do POSSUM and P-POSSUM scores accurately predict morbidity and mortality in patients undergoing colorectal surgery?
Cohort (n=551)
No
Do POSSUM and P-POSSUM scores accurately predict morbidity and mortality in patients undergoing colorectal surgery?
Absolute Event Rate: 5.8% vs 5.6%
The P-POSSUM score is an accurate tool for predicting mortality in colorectal surgery patients, whereas the POSSUM score overestimates morbidity and mortality.
P-POSSUM may aid mortality risk stratification in colorectal surgery; leaves open need for prospective validation before routine adoption.
OBJECTIVE: to apply the POSSUM and P-POSSUM scores as a tool to predict morbidity and mortality in colorectal surgery. METHODS: we conducted a prospective cohort study of 551 patients submitted to colorectal surgery in a colorectal surgery tertiary referral hospital in Brazil. We grouped patients into pre-established risk categories for comparison between expected and observed morbidity and mortality rates by the POSSUM and P-POSSUM scores. RESULTS: in the POSSUM morbidity analysis, the overall expected morbidity was significantly higher than that observed (39.2% vs. 15.6%). The same occurred with patients grouped in categories II (28.9% x 10.5) and III (64.6% x 24.5%). In category I, the expected and observed morbidities were similar (13.7% x 9.1%). Regarding the evaluation of mortality, it was statistically higher than that observed in category III patients and in the total number of patients (11.3% vs. 5.6%). In categories I and II, we observed the same pattern of category III, but without statistical significance. When evaluating mortality by the P-POSSUM score, the overall expected and observed mortality was similar (5.8% x 5.6%). Of the 31 patients who died, 20.2% underwent emergency procedures and sepsis was the main cause of death. CONCLUSION: the P-POSSUM score was an accurate tool to predict mortality and could be safely used in this population profile, unlike the POSSUM score.
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CARVALHO-E-CARVALHO et al. (2018) conducted a cohort in colorectal surgery (n=551). POSSUM and P-POSSUM scores vs. Observed clinical outcomes was evaluated on overall mortality by P-POSSUM score. The P-POSSUM score accurately predicted overall mortality (expected 5.8% vs. observed 5.6%), whereas the POSSUM score significantly overestimated overall morbidity (expected 39.2% vs. observed 15.6%).
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