Abstract
Scoring systems have been developed to predict the expected mortality and morbidity in surgical procedures. In this study, our aim was to compare the ASA (American Society of Anesthesiologists), APACHE (Acute Physiology and Chronic Health Evaluation) II, POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) scoring systems as predictors of mortality in patients who underwent gastrointestinal oncologic surgery, followed, and were admitted to the intensive care unit during the postoperative period. We examined the files of 82 patients who underwent oncologic gastrointestinal surgery and followed up in the intensive care units (ICUs). The patients’ APACHE II scores and predicted mortality rates (PMR) according to the APACHE II, POSSUM, and ASA scores were calculated. The receiver operator characteristic (ROC) curve analysis was used when evaluating the performances of the ASA, APACHE, and POSSUM scoring systems in terms of accurate assessment of mortality. Accordingly, the area under the curve (AUC) = 0.5 no distinction, 0.5 <AUC <0.7 discriminative power of the test is statistically not significant, 0.7 <AUC <0.8 acceptable, 0.8 <AUC <0.9 very good and 0.9 <AUC <1 perfect. The evaluations showed that APACHE II had the best performance with 0.81, followed by POSSUM, which had an acceptable level at 0.78. On the other hand, the ASA score was 0.63 and its discriminative power was identified as statistically insignificant. Our results show that the POSSUM and APACHE II scoring systems were better at predicting mortality than the ASA scoring system for the prediction of mortality in the postoperative period. Both the POSSUM and APACHE II scoring systems can be confidently used for the prediction of mortality in patients undergoing operations due to oncologic gastrointestinal diseases.
Highlights
Surgeries for gastrointestinal tumors are frequent oncologic surgical cases, and both genetic and environmental factors have been known to play important roles in the etiology [1]
When we evaluated the relationship between age and mortality rate, we determined the following: four of the patients < 70 years group (4.8%) and five for the ≥ 70 years group (17.5%) were dead
We found that the APACHE II and POSSUM scoring systems are demonstrative for predicting mortality rate gastrointestinal tract surgery
Summary
Surgeries for gastrointestinal tumors are frequent oncologic surgical cases, and both genetic and environmental factors have been known to play important roles in the etiology [1]. The ASA (American Society of Anesthesiologists) scoring system is the preoperative classification used to estimate peri/postoperative and mortality in patients who will undergo surgery; it is a simple, subjective measure of comorbidity that has been widely used since 1963 [2]. This scoring system is a reliable indicator for risk, and its predictive value increases when age is taken into account [3]. The APACHE scoring system has been found to be useful for comparing the success of the intensive care unit (ICU). This system is too complex for routine use; Knaus et al developed the APACHE II system, which is simpler and clinically more useful [4]
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