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Parameters for Calculating P-POSSUM Score a
Source publication
To compare the Portsmouth (P) Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) and specialized colorectal (Cr) POSSUM scoring systems in the prediction of mortality after resection of colorectal cancer.
Retrospective study of patients after resection of colorectal cancer.
University hospital.
One hu...
Contexts in source publication
Context 1
... patients for whom P-POSSUM and Cr-POSSUM scores could not be calculated because of lack of data were excluded. Parameters for calculating P-POSSUM and Cr-POSSUM are given in Table1 and Table 2. The remaining 120 patients were included in the study. ...Context 2
... this analysis, patients were stratified into risk groups on the basis of predicted mortality. The predicted number of deaths in each risk group was compared with the observed number of deaths using the Hosmer-Lemeshaw goodness-of-fit test (Tables 1-3). Both scores demonstrated good calibration ability, with no statistically significant differences in observed to expected number of deaths. ...Citations
... Although not statistically significant, a value > 10 on CR-POSSUM score showed a statistical trend for 30day mortality (p = 0.059). At this point, no other series has used the CR-POSSUM score in pelvic exenteration, since, generally, it is used for elective colorectal surgery with or without cancer 19,20 . Cheung et al. ...
... Despite their widespread use, however, these scores show certain limitations, including a high inconsistency between ratings 48,49 , and the tendency to under-or over predict mortality in low-risk surgical patients [51][52][53][54] . They also consider no (ASA-ps) or few (POSSUM) surgery-related variables 55 . In 2015, the ASPRA score was implemented and tested, showing good predictive ability, as from the ROC curves, remarkably good negative predictive value for scores > 7, and a trend towards a positive association between higher scores and more severe complications as defined by the Clavien-Dindo score. ...
An accurate assessment of preoperative risk may improve use of hospital resources and reduce morbidity and mortality in high-risk surgical patients. This study aims at implementing an automated surgical risk calculator based on Artificial Neural Network technology to identify patients at risk for postoperative complications. We developed the new SUMPOT based on risk factors previously used in other scoring systems and tested it in a cohort of 560 surgical patients undergoing elective or emergency procedures and subsequently admitted to intensive care units, high-dependency units or standard wards. The whole dataset was divided into a training set, to train the predictive model, and a testing set, to assess generalization performance. The effectiveness of the Artificial Neural Network is a measure of the accuracy in detecting those patients who will develop postoperative complications. A total of 560 surgical patients entered the analysis. Among them, 77 patients (13.7%) suffered from one or more postoperative complications (PoCs), while 483 patients (86.3%) did not. The trained Artificial Neural Network returned an average classification accuracy of 90% in the testing set. Specifically, classification accuracy was 90.2% in the control group (46 patients out of 51 were correctly classified) and 88.9% in the PoC group (8 patients out of 9 were correctly classified). The Artificial Neural Network showed good performance in predicting presence/absence of postoperative complications, suggesting its potential value for perioperative management of surgical patients. Further clinical studies are required to confirm its applicability in routine clinical practice.
... The association between blood loss and postoperative complications has been reported in colorectal surgery [2,4,5,14], as well as in a range of specialties, including hepatic, gastric and cardiothoracic surgery [15][16][17]. Furthermore, EBL is used in predictive scores of postoperative adverse events in surgery, such as P-POSSUM [18,19]. However, estimation of blood loss for a surgical procedure is both poorly reproducible and typically underestimated [20]. ...
Purpose
Intraoperative estimated blood loss (EBL) is often reported in nearly all surgical papers; however, there is no consensus regarding its measurement. The aim of this study was to determine whether EBL (ml) is as reliable and reproducible in predicting complications as a simple binary grading of EBL.
Methods
All consecutive patients undergoing colectomies between January 2015 and December 2018 were included. EBL was assessed prospectively by the surgeon and anaesthesiologist in ml and with a binary scale: bleeding “as usual” versus “more than usual” by the surgeon. Differences between pre- and post-operative haemoglobin levels (ΔHb g/dl) were correlated to EBL. Blood loss impact on 30-day postoperative morbidity was analysed.
Results
A total of 270 patients were included, with a mean age of 65 years (SD 17). Mean EBL documented by surgeons correlated to EBL by anaesthesiologists (79.5 ml, SD 99 vs. 84.5 ml, SD 118, ϱ = 0.926, p < 0.001). Surgeons and anaesthesiologists’ EBL correlated also with ΔHb (ϱ = − 0.273, p = 0.01 and ϱ = − 0.344, p = 0.01, respectively). Patient with surgeon EBL ≥ 250 ml or graded as “more than usual” bleeding had significantly more severe complications (8% vs. 20%, p = 0.02 and 8% vs. 27%, p = 0.001, respectively).
Conclusion
Anaesthesiologist and surgeon’s EBL correlated with ΔHb. Simple grading of blood loss as “usual” and “more than usual” predicted severe complications and higher mortality rates. This simple binary grading of blood loss in colon surgery could be an alternative to the estimation of blood loss in ml as it is easy to apply but needs to be validated externally.
... Instead, they used the same variables to conduct linear analysis of the original POS-SUM equation and proposed P-POSSUM (Portsmouth-POSSUM) [26], which has been shown to have a more accurate mortality prediction [27]. However, some studies reported that the accuracy of P-POSSUM fluctuates greatly [28]. In 2003, Prytherch et al. [29] proposed the Biochemistry and Haematology Outcome Model (BHOM), using fewer objective variables to predict postoperative mortality. ...
Background
The misestimation of surgical risk is a serious threat to the lives of patients when implementing surgical risk calculator. Improving the accuracy of postoperative risk prediction has received much attention and many methods have been proposed to cope with this problem in the past decades. However, those linear approaches are inable to capture the non-linear interactions between risk factors, which have been proved to play an important role in the complex physiology of the human body, and thus may attenuate the performance of surgical risk calculators.
Methods
In this paper, we presented a new surgical risk calculator based on a non-linear ensemble algorithm named Gradient Boosting Decision Tree (GBDT) model, and explored the corresponding pipeline to support it. In order to improve the practicability of our approach, we designed three different modes to deal with different data situations. Meanwhile, considering that one of the obstacles to clinical acceptance of surgical risk calculators was that the model was too complex to be used in practice, we reduced the number of input risk factors according to the importance of them in GBDT. In addition, we also built some baseline models and similar models to compare with our approach.
Results
The data we used was three-year clinical data from Surgical Outcome Monitoring and Improvement Program (SOMIP) launched by the Hospital Authority of Hong Kong. In all experiments our approach shows excellent performance, among which the best result of area under curve (AUC), Hosmer–Lemeshow test ( $${{\mathrm{HL}}}_{\hat{c}}$$ HL c ^ ) and brier score (BS) can reach 0.902, 7.398 and 0.047 respectively. After feature reduction, the best result of AUC, $${\mathrm{HL}}_{\hat{c}}$$ HL c ^ and BS of our approach can still be maintained at 0.894, 7.638 and 0.060, respectively. In addition, we also performed multiple groups of comparative experiments. The results show that our approach has a stable advantage in each evaluation indicator.
Conclusions
The experimental results demonstrate that NL-SRC can not only improve the accuracy of predicting the surgical risk of patients, but also effectively capture important risk factors and their interactions. Meanwhile, it also has excellent performance on the mixed data from multiple surgical fields.
... Despite their widespread use, however, these scores show certain limitations, including a high inconsistency between ratings 24,40 , and the tendency to under-or over predict mortality in low-risk surgical patients 11,50,59,60 . They also consider no (ASA-ps) or few (POSSUM) surgery-related variables 26 . In 2015, the ASPRA score was implemented and tested, showing good predictive ability, as from the ROC curves, remarkably good negative predictive value for scores > 7, and a trend towards a positive association between higher scores and more severe complications as defined by the Clavien-Dindo score. ...
An accurate assessment of preoperative risk may improve use of hospital resources and reduce morbidity and mortality inhigh-risk surgical patients. This study aims at implementing an automated surgical risk calculator based on Artificial NeuralNetwork technology to identify patients at risk for postoperative complications.
We developed the new SUMPOT based on risk factors previously used in other scoring systems and tested it in a cohortof 560 surgical patients undergoing elective or emergency procedures and subsequently admitted to intensive care units,high-dependency units or standard wards. The whole dataset was divided into a training set, to train the predictive model, anda testing set, to assess generalization performance. The effectiveness of the Artificial Neural Network is a measure of theaccuracy in detecting those patients who will develop postoperative complications.
A total of 560 surgical patients entered the analysis. Among them, 77 patients (13.7%) suffered from one or more postoperativecomplications (PoCs), while 483 patients (86.3%) did not. The trained Artificial Neural Network returned an average classificationaccuracy of 90% in the testing set. Specifically, classification accuracy was 90.2% in the control group (46 patients out of 51were correctly classified) and 88.9% in the PoC group (8 patients out of 9 were correctly classified).
The Artificial Neural Network showed good performance in predicting presence/absence of postoperative complications,suggesting its potential value for perioperative management of surgical patients. Further clinical studies are required to confirmits applicability in routine clinical practice.
... Aunque no es estadísticamente significativo, un valor > 10 en la puntuación CR-POSSUM mostró una tendencia estadística de mortalidad a los 30 días (p = 0.059). En este punto, ninguna otra serie ha utilizado la puntuación CR-POSSUM en la exenteración pélvica, pues generalmente se usa para la cirugía colorrectal electiva con o sin cáncer 19,20 . Cheung, et al. ...
Objetivo:
El objetivo de este trabajo fue analizar los resultados perioperatorios y a largo plazo de los pacientes sometidos a exenteración pélvica para cáncer de recto en un centro de referencia en la Ciudad de México.
Método:
Se incluyeron todos los pacientes que se sometieron a exenteración pélvica por cáncer de recto entre 1995 y 2019. Se analizaron variables demográficas, clínicas, quirúrgicas y patológicas.
Resultados:
Se incluyeron 18 pacientes operados por cáncer de recto (16 localmente avanzados y 2 recurrentes). La relación hombre: mujer fue de 1:3.5. La morbilidad mayor fue del 27.7%. El sangrado intraoperatorio ≥ 1000 ml se asoció con morbilidad (80 vs. 20%; p = 0,029) y mortalidad posoperatoria (100 vs. 0; p = 0.043). La mediana de sobrevida global fue 102 meses. Las sobrevidas global y libre de enfermedad a los 5 años fueron del 44.4% y el 38.8%, respectivamente. La invasión linfovascular fue un factor de mal pronóstico para sobrevida libre de enfermedad (p = 0.017).
Conclusiones:
La exenteración pélvica para el cáncer de recto es un procedimiento quirúrgico con altas morbilidad y mortalidad. La invasión linfovascular es un factor de mal pronóstico para la sobrevida libre de enfermedad.
... However, all scoring systems tend to optimize the fit of the data to the original population. Although during development, Cr-POSSUM fitted the data well in both the development and validation sets, it is important to cross-validate the scoring system externally by applying the model to a different population to assess its predictive power 19 . There are some limitation of this study. ...
Background: "Portsmouth" modification of POSSUM (P-POSSUM) scoring system used to assess mortality in general surgical patients and “Colorectal” Cr-POSSUM scoring system used for mortality assessment for colorectal patient. Objective: The purpose of the present study was to estimate the validity of the P-POSSUM (Portsmouth-POSSUM) and Cr-POSSUM (Colorectal-POSSUM) score in predicting the risk of mortality in colorectal cancer patient. Methodology: This was single centre clinical trial was carried out in the Department of Surgery at Dhaka Medical College Hospital, Dhaka, Bangladesh from November 2013 to April 2014 for a period of six (06) months. Patients of both sex who got admitted in the surgery in-patient department for elective colorectal cancer operations were selected as study population. Both the P-POSSUM and Cr-POSSUM, physiological score, operative score, predicted mortality rate were calculated using an online POSSUM calculator. Based on both P-POSSUM and Cr-POSSUM Scoring, patients were categorized into three risk groups. Then a comparative analysis was performed between the observed and the predicted values as well as the Observed/Predicted ratio (O:P) in all the risk groups. Results: A total of 50 patients with the median age of 50 (ranging 20 to 72) years were studied. 30 days overall observed mortality was 3(6%) patients. The mean P-POSSUM and C-POSSUM physiological scores were 32.49±2.08 and 13.92±1.30 respectively. However, the operative score was 11.59±1.46 and 8.12±0.24 in P-POSSUM and C-POSSUM respectively. The overall mortality predicted by the P-POSSUM model was 5 patients (19.33±2.87) and mortality predicted by the Cr-POSSUM model was 4 patients (20.66±4.09). Conclusion: In conclusion both model accurately predicted the risk of postoperative death. Cr-POSSUM provided a better fit to observed results than P-POSSUM. Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 118-123
... Predicting postoperative complications is important since it allows to preoperatively identify patients with specific needs and to influence the surgical strategy. Different scores have been proposed in order to predict the risk for complications or death in the postoperative period after colonic resection (CR) (POSSUM, P-POSSUM, CR-POSSUM, ACPGBI score…) [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. However, none of them has been implemented into the routine clinical practice, probably because they incorporate a large number of variables (11 median, between 3 and 66) [16]. ...
... It reduces the number of P-POSSUM parameters down to six physiological and four surgical parameters, hence simplifying the computing. Further studies showed that the POSSUM-based score models can be used to predict the mortality in populations, but are less accurate in predicting the risk of death in patients on individual basis [6][7][8][9][10][11]. Previous reviews consider the original POSSUM model accurate enough in predicting post-operative complications after colorectal cancer surgery, P-POSSUM being the most accurate for predicting post-operative mortality [12]. ...
PurposePredicting postoperative complications and mortality is important to plan the surgical strategy. Different scores have been proposed before to predict them but none of them have been yet implemented into the routine clinical practice because their difficulties and low accuracy with new surgical strategies and enhanced recovery. The main aim of this study is to identify risk factors for postoperative morbidity and mortality after colonic resection (CR) without protective stomas, in order to develop a comprehensive, up-to-date, simple, reliable, and applicable model for the preoperative assessment of patients with colon cancer.Methods
Multivariable analysis was performed to identify risk factors for 60-day morbidity and mortality. Coefficients derived from the regression model were used in the nomograms to predict morbidity and mortality.ResultsThree thousand one hundred ninety-three patients from 52 hospitals were included into the analysis. Sixty-day postoperative complications rate was 28.3% and the mortality rate was 3%. In multivariable analysis the independent risk factors for postoperative complications were age, male gender, liver and pulmonary diseases, obesity, preoperative albumin, anticoagulant treatment, open surgery, intraoperative complications, and urgent surgery. Independent risk factors for mortality were age, preoperative albumin anticoagulant treatment, and intraoperative complications.Conclusions
Risk factors for morbidity and mortality after CR for cancer were identified and two easy predictive tools were developed. Both of them could provide important information for preoperative consultation and surgical planning in the time of enhance recovery.
... To our knowledge, this is the first time that the utility of serum bicarbonate in the peri-operative setting of cancer has been demonstrated. Prior to this study, a number of general operative scores such as the P-POSSUM score have utilized and incorporated a number of other routine serum tests together to provide an estimation of operative risk [15,16]. However, there is no prior publication or score that had assessed or incorporated serum bicarbonate level. ...
... In the current study we assessed the utility of serum bicarbonate whilst controlling for other significant factors previously utilized in the different POSSUM scores. We chose to specifically utilize factors from the POSSUM scores as opposed to other peri-operative instruments because the POSSUM family of scores has been validated numerous times clinically [16,17]. In the current study, serum bicarbonate was found to be the most significant factor for peri-operative mortality in multivariable analysis even when adjusted for other key factors such as poor renal function or electrolyte disturbance. ...
... Firstly, we lacked information on whether the nature of a patient's presentation was elective or emergent. However even in prior scoring systems for peri-operative mortality, emergent presentations were only one prognostic factor amongst many [15,16]. Indeed, when we adjusted for many of these factors, serum bicarbonate remained significantly prognostic. ...
Aims
Inflammation is a hallmark of cancer whose activity is modulated within the tumor microenvironment by low tumoral pH. Recent evidence in the literature has suggested a link between low serum bicarbonate, low tumoral pH and cancer related inflammation. There is however little clinical evidence in human patients regarding the prognostic role of serum bicarbonate. Therefore, the primary aim of this study was to investigate the short and long-term prognostic utility of serum bicarbonate in colorectal cancer (CRC) patients undergoing resection of their primary tumor. The study also aimed to investigate the association of serum bicarbonate with known markers of systemic inflammation.
Methods
A total of 3281 consecutive patients who underwent surgical resection of their primary CRC from January 1998 to December 2012. Of these, 2223 stage I-IV patients had available data for analysis. The association of serum bicarbonate with overall survival was assessed using univariate and multivariate cox regression analyses. The association of bicarbonate with other clinicopathological variables was assessed by chi squared and Fisher’s exact tests.
Results
Serum bicarbonate was associated with peri-operative mortality in multivariate analysis (p<0.001). Age (p = 0.004), grade (p = 0.043), creatinine (p = 0.036) and sodium (p = 0.036) were also markers associated with peri-operative mortality. For long term survival at 5 years, bicarbonate was significantly associated with overall survival in univariate analysis (p<0.001) but was not significant in multivariate analysis (p = 0.075). In exploratory analysis, serum bicarbonate was found to be significantly associated with the lymphocyte-to-monocyte ratio (p<0.001) and neutrophil-to-lymphocyte ratio (p<0.001).
Conclusions
In peri-operative colorectal cancer patients, serum bicarbonate was associated with 30-day survival but not 5-year survival.
... Regarding morbidity, further studies are needed to validate a score that accurately predicts morbidity in both low and high-risk patients. As seen previously seen [14][15][16] , the use of CR-POSSUM may be more adequate to the profile of the population studied, but other studies are necessary to validate its adoption. ...
... The CR-POSSUM evaluates the physiological variables age, cardiovascular system, systolic pressure, pulse rate, hemoglobin and urea, and the surgical variables peritoneal contamination, malignancy status and surgery size. A study comparing POSSUM and CR-POSSUM as predictors of mortality in 120 patients who underwent surgical resection for colorectal cancer showed that P-POSSUM, despite a non-significant overestimation of mortality in 25%, may be used to predict mortality.However, when compared to CR-POSSUM, this variant was more accurate14 . Two other prospective studies evaluated the use of the POSSUM score to predict morbidity and mortality in colorectal surgeries in 304 and 899 patients15,16 . ...
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.
