Portsmouth POSSUM Research Articles

“An Analytical Study To Compare The Effectiveness Of P-Possum And Possum Scores In Predicting Mortality And Morbidity Following Emergency Laparotomy"

Background: Surgical outcomes are increasingly scrutinized as part of efforts to ensure accountability and improve the quality of care. The Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) and its modification, the Portsmouth POSSUM (P-POSSUM), are widely used tools for predicting surgical outcomes. Objective: This study aimed to assess the accuracy of POSSUM in predicting morbidity and P-POSSUM in predicting mortality for patients undergoing emergency laparotomies in a North Indian tertiary care center. Methods: A hospital-based, analytic observational study was conducted at S.M.S. Medical College and Hospital, Jaipur, involving 160 patients who underwent emergency laparotomy. Preoperative physiological and intraoperative data were collected and used to calculate POSSUM and P-POSSUM scores. Mortality predictions were compared using linear and exponential analyses, and the observed-to-expected (O:E) mortality ratio was calculated. Statistical significance was determined using the Chi-square test. Results: The mean age of the cohort was 49.65 years, with males comprising 64.37% of the population. Peptic perforation (20.6%) was the most common cause of surgery. POSSUM significantly over-predicted mortality (O:E ratio = 0.26, p=0.04), while P-POSSUM provided a more accurate prediction (O:E ratio = 0.45, p=0.81). POSSUM also overestimated morbidity (O:E ratio = 0.8, p=0.51). Conclusion: While POSSUM tends to over-predict both mortality and morbidity, P-POSSUM offers a more accurate prediction of mortality in patients undergoing emergency laparotomy. These scoring systems can serve as valuable tools for surgical audits and improving the quality of care, though careful selection of the appropriate predictive model is essential

Abstract No.: ABS3159: Utility of prognostic scores in prediction of mortality after emergency surgery in COVID-19 patients – A prospective observational cohort study

Background and Aims:Pre-operative prognostic scoring in emergency surgeries is important for informed consent and optimum resource allocation. The accuracy of pre-operative prognostic scores in patients with coronavirus disease (COVID-19) has not been studied. This study aimed to evaluate prognostic scoring tools in COVID-19 patients.Methods:A prospective, observational cohort study was conducted in adults with confirmed COVID-19 infection within 7 weeks before or 1 week after emergency surgery. (1) Demographic data, prognostic risk scores [American Association of Anaesthesiologists Physical Classification (ASA), sequential organ failure assessment (SOFA), quick SOFA (qSOFA), Physiologic and Operative Severity Score for enUmeration of Mortality and Morbidity (POSSUM), and Portsmouth POSSUM (P-POSSUM) scores], and surgical and anaesthetic factors were noted along with morbidity and 30-day mortality. The correlation of prognostic scores and mortality was evaluated using univariate Cox proportional hazards regression, receiver operating characteristic curves (ROCs), Youden’s index, and the Hosmer–Lemeshow goodness-of-fit model.Results:Sixty-seven COVID-19 patients underwent emergency surgery during the study period. The overall mortality was 19%, with the highest in gastro-intestinal/general surgery and sinus surgery. Positive qSOFA and ASA 3E/4E were associated with 9.03 and 12.7 times higher mortality risk, respectively. Each unit increase of SOFA-, POSSUM-, and P-POSSUM-predicted mortality scores led to 50%, 7%, and 6% higher mortality. SOFA, POSSUM, and P-POSSUM area under the curve–ROC curves showed good discrimination between survivors and non-survivors (AUC 0.8829, 0.85, and 0.86, respectively).Conclusion:The overall mortality was comparable to the published literature. (2) SOFA, POSSUM, and P-POSSUM models are good prognostictools for predicting the post-operative 30-day mortality in COVID-19 patients. qSOFA, a simple, clinical, objective tool, also has an aprognostic value.

Validation of the Surgical Outcome Risk Tool (SORT) for Predicting Postoperative Mortality in Colorectal Cancer Patients Undergoing Surgery and Subgroup Analysis.

The accurate evaluation of perioperative risk is crucial to facilitate the shared decision-making process. Surgical outcome risk tool (SORT) has been developed to provide enhanced and more feasible identification of high-risk surgical patients. Nonetheless, SORT has not been validated for patients with colorectal cancer undergoing surgery. Our aim was to determine whether SORT can accurately predict mortality after surgery for colorectal cancer and to compare it with traditional risk models. 526 patients undergoing surgery performed by a colorectal surgical team in a single Greek tertiary hospital (2011-2019) were included. Five risk models were evaluated: (1) SORT, (2) Physiology and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), (3) Portsmouth POSSUM (P-POSSUM), (4) Colorectal POSSUM (CR-POSSUM), and (5) the Association of Great Britain and Ireland (ACPGBI) score. Model accuracy was assessed by observed to expected (O:E) ratios, and area under Receiver Operating Characteristic curve (AUC). Ten patients (1.9%) died within 30days of surgery. SORT was associated with an excellent level of discrimination [AUC:0.81 (95% CI:0.68-0.94); p = 0.001] and provided the best performing calibration of all models in the entire dataset analysis (H-L:2.82; p = 0.83). Nonetheless, SORT underestimated mortality. SORT model demonstrated excellent discrimination and calibration predicting perioperative mortality in patients undergoing (1) open surgery, (2) emergency/acute surgery, and (3) in cases with colon-located cancer. SORT is an easily adopted risk-assessment tool, associated with enhanced accuracy, that could be implemented in the perioperative pathway of patients undergoing surgery for colorectal cancer.

POSSUM and P-POSSUM Scoring in Hip Fracture Mortalities.

Introduction:Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) are general surgical tools used to efficiently assess mortality and morbidity risk. Data suggest that these tools can be used in hip fracture patients to predict morbidity and mortality; however, it is unclear what score indicates a significant risk on a case-by-case basis. We examined the POSSUM and P-POSSUM scores in a group of hip fracture mortalities in order to assess their accuracy in identification of similar high-risk patients.Materials and Methods:Retrospective analysis of all consecutive mortalities in hip fracture patients at a single tertiary care center over 2 years was performed. Patient medical records were examined for baseline demographics, fracture characteristics, surgical interventions, and cause of death. Twelve physiological and 6 operative variables were used to retrospectively calculate POSSUM and P-POSSUM scores at the time of injury.Results:Forty-seven hip fracture mortalities were reviewed. Median patient age was 88 years (range: 56-99). Overall, 68.1% (32) underwent surgical intervention. Mean predicted POSSUM morbidity and mortality rates were 73.9% (28%-99%) and 31.1% (5%-83%), respectively. The mean predicted P-POSSUM mortality rate was 26.4% (1%-91%) and 53.2% (25) had a P-POSSUM predicted mortality of >20%. Subgroup analysis demonstrated poor agreement between predicted mortality and observed mortality rate for POSSUM in operative (χ2 = 127.5, P < .00001) and nonoperative cohorts (χ2 = 14.6, P < .00001), in addition to P-POSSUM operative (χ2 = 101.9, P < .00001) and nonoperative (χ2 = 11.9, P < .00001) scoring.Discussion/Conclusion:Hip fracture patients are at significant risk of both morbidity and mortality. A reliable, replicable, and accurate tool to represent the expected risk of such complications could help facilitate clinical decision-making to determine the optimal level of care. Screening tools such as POSSUM and P-POSSUM have limitations in accurately identifying high-risk hip fracture patients.

Portsmouth POSSUM System in General Surgical Practice and Identifying Risk Factors for Low Outcome

Portsmouth POSSUM System in General Surgical Practice and Identifying Risk Factors for Low Outcome

Evaluation of Portsmouth POSSUM in predicting the mortality of patients undergoing major abdominal surgeries

Evaluation of Portsmouth POSSUM in predicting the mortality of patients undergoing major abdominal surgeries

Evaluation of POSSUM and P-POSSUM in pancreatic surgery

The POSSUM is a scoring system which is used for estimating mortality and morbidity risk in major operations. Its reliability on predicting and quantifying the impact of complications was proven in previous studies. P-POSSUM is better in predicting mortality after major surgery. The use of POSSUM and PPOSSUM after pancreatic surgery was evaluated previously with varied results. Aim: The aim of the study was to evaluate the use of POSSUM and Portsmouth (P) POSSUM scoring systems to predict postoperative mortality after pancreatic surgery. POSSUM was also evaluated for predicting morbidity and major morbidity after pancreatic surgery. Material and methods: This was a prospective study done in the Department of Surgical Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad between Feb 2007 and Jun 2009.POSSUM and P-POSSUM as predictors of morbidity and mortality was analysed. The observed morbidity and mortality were then compared with the predicted figure calculated using POSSUM and PPOSSUM. Linear method of analysis was used to calculate morbidity and mortality. Results: One Hundred and Seven patients underwent elective pancreatic surgeries (pancreaticoduodenectomy in 64) between Feb 2007 to Jun 2009. Possum over predicted mortality (Observed: Expected =0.5:1) and P-POSSUM under predicted mortality (Observed: Expected = 1.5:1) after pancreatic surgery. POSSUM under predicted morbidity (Observed: Expected = 1.6:1). However, when major morbidity alone is taken into consideration POSSUM over predicted mortality (Observed: Expected = 0.7:1). The mean Physiology score and operative score was similar in patients with morbidity and mortality compared with no morbidity and mortality. Similar results were found when only patients with pancreaticoduodenectomy were considered. Conclusion: POSSUM and P-POSSUM did not accurately predict mortality and morbidity in patients undergoing pancreatic surgery.

Surgical Intuition.

Surgical Intuition.

Perioperative risk prediction in the era of enhanced recovery: a comparison of POSSUM, ACPGBI, and E-PASS scoring systems in major surgical procedures of the colorectal surgeon

PurposeThis study aims to determine whether traditional risk models can accurately predict morbidity and mortality in patients undergoing major surgery by colorectal surgeons within an enhanced recovery program.MethodsOne thousand three hundred eighty patients undergoing surgery performed by colorectal surgeons in a single UK hospital (2008–2013) were included. Six risk models were evaluated: (1) Physiology and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), (2) Portsmouth POSSUM (P-POSSUM), (3) ColoRectal (CR-POSSUM), (4) Elderly POSSUM (E-POSSUM), (5) the Association of Great Britain and Ireland (ACPGBI) score, and (6) modified Estimation of Physiologic Ability and Surgical Stress Score (E-PASS). Model accuracy was assessed by observed to expected (O:E) ratios and area under Receiver Operating Characteristic curve (AUC).ResultsEleven patients (0.8%) died and 143 patients (10.4%) had a major complication within 30 days of surgery. All models overpredicted mortality and had poor discrimination: POSSUM 8.5% (O:E 0.09, AUC 0.56), P-POSSUM 2.2% (O:E 0.37, AUC 0.56), CR-POSSUM 7.1% (O:E 0.11, AUC 0.61), and E-PASS 3.0% (O:E 0.27, AUC 0.46). ACPGBI overestimated mortality in patients undergoing surgery for cancer 4.4% (O:E = 0.28, AUC = 0.41). Predicted morbidity was also overestimated by POSSUM 32.7% (O:E = 0.32, AUC = 0.51). E-POSSUM overestimated mortality (3.25%, O:E 0.57 AUC = 0.54) and morbidity (37.4%, O:E 0.30 AUC = 0.53) in patients aged ≥ 70 years and over.ConclusionAll models overestimated mortality and morbidity. New models are required to accurately predict the risk of adverse outcome in patients undergoing major abdominal surgery taking into account the reduced physiological and operative insult of laparoscopic surgery and enhanced recovery care.

Thirty-day mortality in patients undergoing laparotomy for small bowel obstruction

Small bowel obstruction (SBO) is a common indication for emergency laparotomy. There are currently variations in the timing of surgery for patients with SBO and limited evidence on whether delayed surgery affects outcomes. The aim of this study was to evaluate the impact of time to operation on 30-day mortality in patients requiring emergency laparotomy for SBO. Data were collected from the National Emergency Laparotomy Audit (NELA) on all patients aged 18 years or older who underwent emergency laparotomy for all forms of SBO between December 2013 and November 2015. The primary outcome measure was 30-day mortality, with date of death obtained from the Office for National Statistics. Patients were grouped according to the time from admission to surgery (less than 24 h, 24-72 h and more than 72 h). A multilevel logistic regression model was used to explore the impact of patient factors, primarily delay to surgery, on 30-day mortality. Some 9991 patients underwent emergency laparotomy requiring adhesiolysis or small bowel resection for SBO. The overall mortality rate was 7·2 per cent (722 patients). Within each time group, 30-day mortality rates were significantly worse with increasing age, ASA grade, Portsmouth POSSUM score and level of contamination. Patients undergoing emergency laparotomy more than 72 h after admission had a significantly higher risk-adjusted 30-day mortality rate (odds ratio 1·39, 95 per cent c.i. 1·09 to 1·76). In patients who require an emergency laparotomy with adhesiolysis or resection for SBO, a delay to surgery of more than 72 h is associated with a higher 30-day postoperative mortality rate.

Evaluation of P- POSSUM Scoring System in Patients Undergoing Emergency Laparotomy

Introduction: The Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM) and its modification the Portsmouth POSSUM (P-POSSUM), have been proposed as a method for standardizing patient data so that direct comparisons can be made despite differing patterns of referral and population. In this prospective study, the validity of P-POSSUM was tested in patients undergoing emergency laparotomy and the risk factors for low outcome were noted.Methods: This is the Prospective Study and was conducted in Department of surgery, of a tertiary level hospital. The study period was from April 2014- April 2015 for one year. Patients admitted under department of general surgery scheduled to undergo emergency laparotomy were included and scored according to their physiological and operative findings using a proforma sheet. Physiological scoring was performed just before surgery and operative scoring was carried out intra-operatively. Patients were followed-up for the first 30 days postoperative period. The observed mortality rate was compared with the P-POSSUM predicted mortality rate. Data analysis was done using SPSS 20.Results: A total of 60 patients who met the inclusion criteria were included in this study. On applying linear analysis, an observed to expected ratio of 1.18 was obtained, indicating a significant fit for predicting the post-operative adverse outcome. There was no significant difference between the observed and predicted mortality rates (x2 = 1.467, 4 df., P = 0.833). It was found to be comparable to other studies. In all the risk factors studied, a positive correlation was found between deaths and higher POSSUM scores.Conclusion: Portsmouth POSSUM scoring system serves as a good predictor of post-operative outcome in emergency laparotomy procedures.

Indentifying Risk Factor for Low out Come in General Surgical Practice Using Portsmouth Possum Scoring System

BACKGROUND AND OBJECTIVES: The aim of the present study was to compare the outcome of various surgical modalities using the Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM) and its modification the Portsmouth POSSUM. It should be quick and easy to use and should be applicable to all general surgical procedure in both the emergency and elective situation. It should be of use in all type of hospital and should provide educational information. In this prospective study, the validity of P-POSSUM was test in patient undergoing for major surgery and identifying the risk factor for low out come were noted. METHODS: Prospective study on 75 patients undergoing major surgeries both in emergency and elective sitting .The disease severity was assessed in all patient using P-POOSUM scoring system. Predicted post operative mortality rates was calculated using the P-POSSUM equation by linear analysis method. It was then compared with the actual out comes and also the risk factors as scored in the possum criteria were noted. RESULTS: By Applying linear analysis, an observed to expected ratio of 0.96 was obtained this indicating a significant fit for predicting the post operative adverse outcome. There was no significant difference between the observed and predicted mortality rates (x2 = 1.667, 9 d.f.,P = 0.9957). It was found to be comparable to other studies. In all the risk factors studied, a positive correlation was found between deaths and higher POSSUM scores. INTERPRETATION AND CONCLUSION: To conclude, the present study suggest that the out come of surgical patients is reasonably good. Portsmouth POSSUM scoring system serves as a good predictor of post operative outcome in major general surgical procedures and was applicable even in our setup and be used for comparing various treatment modalities and assessing the quality of care provided.

Portsmouth Possum Scoring in General Surgery, identifying Risk Factors for low outcome And Predicting Post operative Mortality

Portsmouth Possum Scoring in General Surgery, identifying Risk Factors for low outcome And Predicting Post operative Mortality

Physiological and operative severity score for the enumeration of mortality and morbidity scoring systems for assessment of patient outcome and impact of surgeons' and anesthesiologists' performance in hepatopancreaticobiliary surgery.

Context:The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a scoring system used to predict morbidity and mortality.Aims:We compared the physiological and operative risk, the expected morbidity and mortality, and the observed postoperative mortality among patients operated by different surgeons and anesthetized by different anesthesiologists.Settings and Design:This was a retrospective, single center study.Subjects and Methods:The anesthetic records of 159 patients who underwent hepatopancreaticobiliary surgery were analyzed for the physiological and operative severity, POSSUM morbidity, POSSUM and Portsmouth POSSUM (P-POSSUM) mortality scoring systems, observed mortality in 30-days, 3, 6, and 12 months postoperatively, duration of surgery, and units of packed red blood cells (PRBC) transfused. These variables were compared among patients operated by five different surgeons and anesthetized by seven different anesthesiologists.Statistical Analysis:One-way analysis of variance was used for normally and Kruskal–Wallis test for nonnormally distributed responses. Differences in percentages of postoperative mortality were assessed by Chi-squared test.Results:The physiological severity, POSSUM morbidity, POSSUM and P-POSSUM mortality scores, and observed mortality at 1, 3, 6, and 12 months postoperatively did not differ among patients operated by different surgeons and anesthetized by different anesthesiologists. Duration of surgery (P < 0.001), PRBC units transfused (P = 0.002), and operative severity (P = 0.001) differed significantly among patients operated by different surgeons.Conclusions:The physiological severity score, POSSUM and P-POSSUM scores did not differ among patients operated by different surgeons and anesthetized by different anesthesiologists. The different operative severity scores did not influence the observed mortality in the postoperative period.

Mortality risk factor analysis in colonic perforation: would retroperitoneal contamination increase mortality in colonic perforation?

PurposeColonic perforation is a lethal condition presenting high morbidity and mortality in spite of urgent surgical treatment. This study investigated the surgical outcome of patients with colonic perforation associated with retroperitoneal contamination.MethodsRetrospective analysis was performed for 30 patients diagnosed with colonic perforation caused by either inflammation or ischemia who underwent urgent surgical treatment in our facility from January 2005 to December 2014. Patient characteristics were analyzed to find risk factors correlated with increased postoperative mortality. Using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) audit system, the mortality and morbidity rates were estimated to verify the surgical outcomes. Patients with retroperitoneal contamination, defined by the presence of retroperitoneal air in the preoperative abdominopelvic CT, were compared to those without retroperitoneal contamination.ResultsEight out of 30 patients (26.7%) with colonic perforation had died after urgent surgical treatment. Factors associated with mortality included age, American Society of Anesthesiologists (ASA) physical status classification, and the ischemic cause of colonic perforation. Three out of 6 patients (50%) who presented retroperitoneal contamination were deceased. Although the patients with retroperitoneal contamination did not show significant increase in the mortality rate, they showed significantly higher ASA physical status classification than those without retroperitoneal contamination. The mortality rate predicted from Portsmouth POSSUM was higher in the patients with retroperitoneal contamination.ConclusionPatients presenting colonic perforation along with retroperitoneal contamination demonstrated severe comorbidity. However, retroperitoneal contamination was not found to be correlated with the mortality rate.

Does adding ICU data to the POSSUM score improve the prediction of outcomes following surgery for upper gastrointestinal malignancies?

Surgery for upper gastrointestinal malignancy carries a high postoperative mortality and morbidity risk. The importance of preoperative physiological reserve and intraoperative events in determining clinical outcomes is recognised in the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) score that comprises variables relevant to both phases. Whether adding variables linked to ICU admission characteristics improves the predictive capacity of POSSUM is unclear, especially in an Australian/New Zealand healthcare context. This study aimed to evaluate the predictive capacity of the POSSUM score for 30-day mortality and in-hospital morbidity in 80 patients undergoing resection of oesophageal (28%), gastric (26%) or pancreatic (46%) malignancies and admitted to ICU. The 30-day mortality was 8.8% and 65% of patients developed some postoperative complication. Receiver operating characteristics generated an area under the curve (95% CI) to predict mortality by Portsmouth POSSUM of 0.87 (0.77 to 0.93) and morbidity by POSSUM of 0.67 (0.55 to 0.77). Multiple regression analysis including biochemical variables and vital signs on admission to ICU identified renal function parameters, fluid balance and need for cardiorespiratory support beyond the first postoperative day as independent factors associated with mortality and morbidity (in addition to the POSSUM score) but the inclusion of these variables in a logistic regression model did not significantly improve the predictive capacity for mortality (to area under the curve 0.93 [0.85 to 0.97]) or morbidity (to area under the curve 0.67 [0.55 to 0.78]). In conclusion, the POSSUM score provides clinically useful predictive capacity in patients undergoing surgery for upper gastrointestinal malignancies. The incorporation of ICU admission variables to the pre- and intraoperative POSSUM variables did not significantly enhance the precision.

O-POSSUM and P-POSSUM for evaluation of operative risk of aged patients in orthopedic department

Objective To retrospectively review the mortality and morbidity after orthopedic surgery for aged patients with reference to orthopedic version physiological and operative severity score for the enumeration of mortality and morbidity (O-POSSUM) and Portsmouth POSSUM (P-POSSUM) and validate the score' s accuracy in operative risk prediction.Methods O-POSSUM and P-POSSUM for mortality and morbidity were applied to 839 aged patients who had undergone orthopedic surgery between January 2008 and December 2011.Observed mortality and morbidity were compared with the expected values.Results O-POSSUM predicted 230 morbidities,but the observed value was 182 (x2 =2.718,P ＞ 0.05).O-POSSUM predicted 46 deaths,higher than the observed 3 deaths (x2 =38.870,P＜0.01).P-POSSUM predicted 16 deaths,higher than the observed 3 deaths (x2 =8.997,P ＜ 0.01).Conclusions O-POSSUM accurately predicts postoperative morbidity in aged orthopedic patients.However,O-POSSUM and P-POSSUM overpredicts the mortality and should be used with caution. Key words: Aged; Fractures; Prognosis; Orthopedic version physiological and operative severity score for the enumeration of mortality and morbidity

POSSUM and P-POSSUM for risk assessment in general surgery in the elderly.

The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) use preoperative and intraoperative factors to evaluate risk. We examined our surgical results to investigate predictive factors for morbidity and mortality, and evaluate the accuracy of the POSSUM and P-POSSUM. Patients (n = 593) aged ≥80 years, undergoing general surgical procedures were enrolled. Logistic regression analysis was used to determine the independent predictors. The predicted outcomes using POSSUM and P-POSSUM were also compared with actual outcomes. Physiological score (PS) and operative severity score (OS) were independent predictors of morbidity and mortality. Using POSSUM, the observed/expected (O/E) morbidity ratio was 1.44 and O/E mortality ratio was 0.98. Using P-POSSUM, the O/E mortality ratio was 1.0. Even though POSSUM tended to underestimate the morbidity rate, POSSUM and P-POSSUM accurately predicted the mortality rate after general surgical procedures.

Complications and reintervention following elective open abdominal aortic aneurysm repair: a 10-year retrospective analysis.

Recent data have shown higher rates of graft related complication or reintervention in patients undergoing endovascular aneurysm repair compared with open aneurysm surgery (OAS). However, there are fewer data available regarding procedure related reinterventions following OAS. The aim of this study was to investigate the incidence of procedure related complications and reintervention following elective open abdominal aortic aneurysm repair. This was a retrospective analysis of prospectively collected data from the dedicated Portsmouth POSSUM database. Data from 361 patients (median age: 72 years, 91.4% male) who underwent elective OAS between 1993 and 2004 were analysed. The incidences of early and late complications and subsequent reintervention were investigated. The median follow-up duration was 10 years 4 months (range: 5 years - 16 years 4 months). There were 52 reinterventions in the follow-up period. Of these, 34.6% were for incisional hernias or small bowel obstruction with the majority of the remaining laparotomies performed for bleeding or distal ischaemic complications. Almost two-thirds (63.5%) of reinterventions occurred in the first 30 days. There were 30 emergency readmissions to the acute surgical wards that did not require reintervention. OAS carries a significant reintervention rate. In this study, 54% of reinterventions were directly related to laparotomy.

Predictive Value of the POSSUM, p-POSSUM, cr-POSSUM, APACHE II and ACPGBI Scoring Systems in Colorectal Cancer Resection

This study investigated the ability of the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM) scoring system to predict postoperative morbidity (complication rate) and compared the ability of POSSUM and four other scoring systems (Portsmouth POSSUM [p-POSSUM], colorectal POSSUM [cr-POSSUM], Association of Coloproctology of Great Britain and Ireland [ACPGBI] and Acute Physiology and Chronic Health Evaluation II [APACHE II]) to predict mortality within 30 days in 1695 patients undergoing surgery for colorectal cancer. Receiver operating characteristic (ROC) curve, Student's t-test and the χ(2)-test were used to estimate the predictive ability of these scoring systems. The observed complication rate of 38.7% was not significantly different to the rate of 36.3% predicted by the POSSUM scoring system (observed : expected [O : E] ratio 1.07). The observed mortality rate was 3.0%. For predicting mortality, POSSUM had an O : E ratio of 0.37, compared with p-POSSUM O : E ratio 1.00, cr-POSSUM O : E ratio 0.91, APACHE II O : E ratio 0.31 and ACPGBI O : E ratio 1.41. It was concluded that the POSSUM scoring system had high value for predicting the risk of morbidity following colorectal cancer resection. For predicting postoperative mortality, p-POSSUM, cr-POSSUM and ACPGBI were superior to POSSUM and APACHE II, however ROC curve analysis showed that cr-POSSUM and ACPGI discriminated best between survivors and non-survivors, so were more accurate predictors of postoperative mortality than the other three scoring systems.