Modeling for the future: too many POSSUMS?: Invited Commentary on Pelavski, et al. Am J Surg 2013;205:58–63

Abstract

The article by Pelavski et al 1 Pelavski A.D. Lacasta A. De Miguel M. et al. Mortality and surgical risk assessment among the extreme old undergoing emergency surgery. Am J Surg. 2013; 205: 58-63 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar addresses a vexing problem for surgeons caring for very sick elderly patients—how to predict the future. The authors nicely studied predictive models of survival in emergency surgery in nonagenarians, a very sick, usually very frail population of patients. Orthopedic emergencies were excluded, suggesting that the population studied is similar to that of a general surgeon in practice. Although we may not get the answer we want from the article (ie, an accurate way of predicting who will do well after surgery), the good news is that investigators are examining this problem in more detail. They reference a number of recent excellent reports about predicting survival, and more surgeons now have a better foundation to communicate with patients, families, and caregivers before the actual operation. Improved communication with elderly patients and their families is being brought to the forefront, and observational studies have shown that we need to do it better. 2 Redmann A.J. Brasel K.J. Alexander C.G. et al. Use of advance directives for high-risk operations: a national survey of surgeons. Ann Surg. 2012; 255: 418-423 Crossref PubMed Scopus (55) Google Scholar , 3 Cooper Z.R. Powers C.L. Cobb J.P. Putting the patient first: honoring advance directives prior to surgery. Ann Surg. 2012; 255: 424-426 Crossref PubMed Scopus (12) Google Scholar Mortality and surgical risk assessment among the extreme old undergoing emergency surgeryThe American Journal of SurgeryVol. 205Issue 1PreviewAlthough longevity is becoming frequent, there are no scores to assess nonagenarians undergoing emergency surgery. The aim of this prospective observational study was to determine 30-day mortality and the individual performance of the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM) and other scores in predicting their risk for death. Full-Text PDF