Comparison of the risk prediction systems POSSUM and P-POSSUM with the Surgical Risk Scale: A prospective cohort study of 721 patients.

INTRODUCTION: The outcomes of surgery are subject to variability and difficult to be accurately predicted. Different score systems have been developed to estimating the risk of undergoing a surgical procedure. The aim of this study was to assess the predictive ability of POSSUM and P-POSSUM scoring systems, compared to the Surgical Risk Scale (SRS), in Spanish patients undergoing general surgery. PATIENTS AND METHODS: In this prospective observational study, 721 consecutive patients needing a surgical procedure were included. Observed morbidity and mortality after surgery were compared to the expected ones obtained by applying POSSUM, P-POSSUM and SRS. RESULTS: Mean age was 59.2 years (standard deviation (SD): 17.4 years), 43.5% were women. 616 (85.5%) patients underwent elective general surgery and 105 (14.5%) emergency surgery. The 30-day morbidity was 15.4%. The reintervention rate was 2.1% and mortality was 2.1%. The discrimination ability was excellent in predicting mortality. The Area Under the Curve (AUC) values were: POSSUM: AUC = 0.97, C.I.95%: 0.948-0.992, p < 0.0001; P-POSSUM: AUC = 0.966, C.I.95%: 0.941-0.991, p < 0.0001; SRS: AUC = 0.91, C.I.95%:0.853-0.967, p < 0.0001. POSSUM was also discriminative in the prediction of morbidity (AUC = 0.772, C.I.95%: 0.719-0.826, p < 0.0001). POSSUM predicted morbidity and mortality were higher than the observed ones (p = 0.01 and p = 0.04). Predicted and observed mortality were very similar for P-POSSUM (p = 0.93) and SRS (p = 0.37). CONCLUSIONS: Expected morbidity and mortality determined by POSSUM score showed values significantly above the observed ones. P-POSSUM and SRS systems were effective in predicting mortality. The SRS application is simple and may contribute to appropriate medical decision making.

Proteínas mediadoras de la respuesta inflamatoria como predictores de resultados adversos postoperatorios en pacientes quirúrgicos octogenarios: estudio prospectivo observacional / Inflammatory markers as predictors of postoperative adverse outcome in octogenarian surgical patients: An observational prospective study

INTRODUCCIÓN: La utilidad de proteínas mediadoras de la inflamación (alfa-1 glucoproteína e interleucina-6) en la predicción de complicaciones en personas mayores intervenidas quirúrgicamente no está suficientemente establecida. OBJETIVO: Determinar si los niveles preoperatorios de estos marcadores de inflamación se correlacionan con complicaciones postoperatorias en pacientes ancianos, obteniendo las bases para la elaboración de un sistema de predicción de riesgo quirúrgico. MÉTODOS: Estudio prospectivo observacional en pacientes mayores de 80 años, intervenidos quirúrgicamente de procedimientos de cirugía general. Se determinaron preoperatoriamente: edad, sexo, tipo de cirugía, existencia de malignidad, comorbilidades asociadas, el estado físico, mental y nutricional de los pacientes. También marcadores de inflamación: proteína C reactiva, interleucina-6, alfa-1-ácido glucoproteína. Se registraron las complicaciones postoperatorias. Se realizó un análisis multivariante para la obtención de un modelo de predicción de riesgo. RESULTADOS: Se incluyó Se incluyó a 225 pacientes. De ellos, 55 pacientes (24,4%) presentaron complicaciones, con una mortalidad del 5,3%. En el análisis multivariante, las variables interleucina-6, alfa-1-ácido glucoproteína y la presencia de malignidad se asociaron de forma independiente con la existencia de morbilidad. Se utilizaron estas variables para el cálculo de riesgo (R) de morbilidad postoperatoria ajustado por edad. El modelo mostró una sensibilidad del 22,2%, con 94,8% de especificidad, y un porcentaje de correctos clasificados del 78,3%. Área bajo la curva ROC: 0,781 (95% CI: 0,703-0,858). CONCLUSIONES: La valoración conjunta preoperatoria de la existencia de malignidad, niveles de alfa-1-ácido glucoproteína e interleucina-6 puede ser de utilidad en el cálculo del riesgo quirúrgico en ancianos

INTRODUCTION: The value of inflammatory proteins, interleukin-6 and alpha-1-acid glycoprotein as prognostic factors in elderly people undergoing surgery has not been determined yet. Objective To know whether preoperatively determined inflammatory markers may predict the postoperative outcome of elderly patients undergoing surgery. A scoring system for predicting postoperative morbidity was assessed. METHODS: Hospital-based observational prospective study, with geriatric surgical patients. Preoperative determination of following data: age, gender, scheduled or urgent operation, comorbid diseases, malignancy, physical, mental and nutritional profile. Biochemical markers of inflammation, C Reactive Protein, interleukin-6, and alpha-1-acid glycoprotein were also studied. Preoperative data and postoperative complications were recorded. Binary logistic regression analysis was used to obtain a morbidity risk prediction model. RESULTS: A total of 225 patients were included. Fifty-five patients (24.4%) had postoperative complications, with a mortality rate of 5.3%. Binary logistic regression analysis showed an independent relation between morbidity and the variables malignancy, alpha-1-acid glycoprotein and interleukin-6. The risk (R) of postoperative morbidity adjusted by age was calculated. The model showed a 22.2% sensitivity, 94.8% specificity, and a percentage of correct classification of 78.3%. The area under the ROC curve was 0.781 (95% CI: 0.703-0.858). CONCLUSIONS: An age-adjusted equation for predicting 30-day morbidity that included malignancy, serum IL-6 and alpha 1-acid glycoprotein levels may be useful for risk assessment in octogenarian surgical patients

Inflammatory markers as predictors of postoperative adverse outcome in octogenarian surgical patients: an observational prospective study.

INTRODUCTION: The value of inflammatory proteins, interleukin-6 and alpha-1-acid glycoprotein as prognostic factors in elderly people undergoing surgery has not been determined yet. OBJECTIVE: To know whether preoperatively determined inflammatory markers may predict the postoperative outcome of elderly patients undergoing surgery. A scoring system for predicting postoperative morbidity was assessed. METHODS: Hospital-based observational prospective study, with geriatric surgical patients. Preoperative determination of following data: age, gender, scheduled or urgent operation, comorbid diseases, malignancy, physical, mental and nutritional profile. Biochemical markers of inflammation, C Reactive Protein, interleukin-6, and alpha-1-acid glycoprotein were also studied. Preoperative data and postoperative complications were recorded. Binary logistic regression analysis was used to obtain a morbidity risk prediction model. RESULTS: A total of 225 patients were included. Fifty-five patients (24.4%) had postoperative complications, with a mortality rate of 5.3%. Binary logistic regression analysis showed an independent relation between morbidity and the variables malignancy, alpha-1-acid glycoprotein and interleukin-6. The risk (R) of postoperative morbidity adjusted by age was calculated. The model showed a 22.2% sensitivity, 94.8% specificity, and a percentage of correct classification of 78.3%. The area under the ROC curve was 0.781 (95% CI: 0.703-0.858). CONCLUSIONS: An age-adjusted equation for predicting 30-day morbidity that included malignancy, serum IL-6 and alpha 1-acid glycoprotein levels may be useful for risk assessment in octogenarian surgical patients.