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Risk Assessment of Mortality Following Intraoperative Cardiac Arrest Using POSSUM and P-POSSUM in Adults Undergoing Non-Cardiac Surgery.

Kim SH, Kil HK, Kim HJ, Koo BN - Yonsei Med. J. (2015)

Bottom Line: Predicted mortality rates were calculated using POSSUM and P-POSSUM equations and were compared with actual outcomes using exponential and linear analyses.The observed-to-predicted (O:E) ratio for the POSSUM 30-day mortality was 1.07, with no significant difference between the observed and predicted values (χ²=4.794; p=0.779).AUC values (95% CI) were 0.771 (0.634-0.908) and 0.785 (0.651-0.918) for POSSUM and P-POSSUM, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) and its Portsmouth modification (P-POSSUM) are comprehensive assessment methods for evaluating patient and surgical factors widely used to predict 30-day mortality rates. In this retrospective study, we evaluated the usefulness of POSSUM and P-POSSUM in predicting 30-day mortality after intraoperative cardiac arrests in adult patients undergoing non-cardiac surgery.

Materials and methods: Among 190486 patients who underwent anesthesia, 51 experienced intraoperative cardiac arrest as defined in our study protocol. Predicted mortality rates were calculated using POSSUM and P-POSSUM equations and were compared with actual outcomes using exponential and linear analyses. In addition, a receiver operating characteristic curve analysis was undertaken, and area-under-the-curve (AUC) values with confidence intervals (CIs) were calculated for POSSUM and P-POSSUM.

Results: Among the 51 patients with intraoperative cardiac arrest, 32 (62.7%) died within 30 days postoperatively. The overall predicted 30-day mortality rates using POSSUM and P-POSSUM were 65.5% and 57.5%, respectively. The observed-to-predicted (O:E) ratio for the POSSUM 30-day mortality was 1.07, with no significant difference between the observed and predicted values (χ²=4.794; p=0.779). P-POSSUM predicted mortality equally well, with an O:E ratio of 1.10 (χ²=8.905; p=0.350). AUC values (95% CI) were 0.771 (0.634-0.908) and 0.785 (0.651-0.918) for POSSUM and P-POSSUM, respectively.

Conclusion: Both POSSUM and P-POSSUM performed well to predict overall 30-day mortality following intraoperative cardiac arrest in adults undergoing non-cardiac surgery at a university teaching hospital in Korea.

No MeSH data available.


Related in: MedlinePlus

Receiver operator characteristic curves for the POSSUM, P-POSSUM, and American Society of Anesthesiologists (ASA) grade in the prediction of 30-day mortality after intraoperative cardiac arrest. The areaunder-the-curve values with 95% confidence intervals were 0.771 (0.634-0.908), 0.785 (0.651-0.918), and 0.708 (0.549-0.866) for POSSUM, P-POSSUM, and ASA grade, respectively. POSSUM, Physiological and Operative Severity Score for enUmeration of Mortality and morbidity; P-POSSUM, Portsmouth modification POSSUM.
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Figure 1: Receiver operator characteristic curves for the POSSUM, P-POSSUM, and American Society of Anesthesiologists (ASA) grade in the prediction of 30-day mortality after intraoperative cardiac arrest. The areaunder-the-curve values with 95% confidence intervals were 0.771 (0.634-0.908), 0.785 (0.651-0.918), and 0.708 (0.549-0.866) for POSSUM, P-POSSUM, and ASA grade, respectively. POSSUM, Physiological and Operative Severity Score for enUmeration of Mortality and morbidity; P-POSSUM, Portsmouth modification POSSUM.

Mentions: Receiver operating characteristic curves of POSSUM, P-POSSUM, and the ASA grade for predicting 30-day mortality following intraoperative cardiac arrest are shown in Fig. 1. The AUC values with 95% CIs were 0.771 (0.634-0.908), 0.785 (0.651-0.918), and 0.708 (0.549-0.866) for POSSUM, P-POSSUM, and the ASA grade, respectively. There were no statistical differences in the accuracy of the predictions between ASA grade and POSSUM (z=1.208; p=0.227), and P-POSSUM (z= 1.502; p=0.133).


Risk Assessment of Mortality Following Intraoperative Cardiac Arrest Using POSSUM and P-POSSUM in Adults Undergoing Non-Cardiac Surgery.

Kim SH, Kil HK, Kim HJ, Koo BN - Yonsei Med. J. (2015)

Receiver operator characteristic curves for the POSSUM, P-POSSUM, and American Society of Anesthesiologists (ASA) grade in the prediction of 30-day mortality after intraoperative cardiac arrest. The areaunder-the-curve values with 95% confidence intervals were 0.771 (0.634-0.908), 0.785 (0.651-0.918), and 0.708 (0.549-0.866) for POSSUM, P-POSSUM, and ASA grade, respectively. POSSUM, Physiological and Operative Severity Score for enUmeration of Mortality and morbidity; P-POSSUM, Portsmouth modification POSSUM.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541674&req=5

Figure 1: Receiver operator characteristic curves for the POSSUM, P-POSSUM, and American Society of Anesthesiologists (ASA) grade in the prediction of 30-day mortality after intraoperative cardiac arrest. The areaunder-the-curve values with 95% confidence intervals were 0.771 (0.634-0.908), 0.785 (0.651-0.918), and 0.708 (0.549-0.866) for POSSUM, P-POSSUM, and ASA grade, respectively. POSSUM, Physiological and Operative Severity Score for enUmeration of Mortality and morbidity; P-POSSUM, Portsmouth modification POSSUM.
Mentions: Receiver operating characteristic curves of POSSUM, P-POSSUM, and the ASA grade for predicting 30-day mortality following intraoperative cardiac arrest are shown in Fig. 1. The AUC values with 95% CIs were 0.771 (0.634-0.908), 0.785 (0.651-0.918), and 0.708 (0.549-0.866) for POSSUM, P-POSSUM, and the ASA grade, respectively. There were no statistical differences in the accuracy of the predictions between ASA grade and POSSUM (z=1.208; p=0.227), and P-POSSUM (z= 1.502; p=0.133).

Bottom Line: Predicted mortality rates were calculated using POSSUM and P-POSSUM equations and were compared with actual outcomes using exponential and linear analyses.The observed-to-predicted (O:E) ratio for the POSSUM 30-day mortality was 1.07, with no significant difference between the observed and predicted values (χ²=4.794; p=0.779).AUC values (95% CI) were 0.771 (0.634-0.908) and 0.785 (0.651-0.918) for POSSUM and P-POSSUM, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) and its Portsmouth modification (P-POSSUM) are comprehensive assessment methods for evaluating patient and surgical factors widely used to predict 30-day mortality rates. In this retrospective study, we evaluated the usefulness of POSSUM and P-POSSUM in predicting 30-day mortality after intraoperative cardiac arrests in adult patients undergoing non-cardiac surgery.

Materials and methods: Among 190486 patients who underwent anesthesia, 51 experienced intraoperative cardiac arrest as defined in our study protocol. Predicted mortality rates were calculated using POSSUM and P-POSSUM equations and were compared with actual outcomes using exponential and linear analyses. In addition, a receiver operating characteristic curve analysis was undertaken, and area-under-the-curve (AUC) values with confidence intervals (CIs) were calculated for POSSUM and P-POSSUM.

Results: Among the 51 patients with intraoperative cardiac arrest, 32 (62.7%) died within 30 days postoperatively. The overall predicted 30-day mortality rates using POSSUM and P-POSSUM were 65.5% and 57.5%, respectively. The observed-to-predicted (O:E) ratio for the POSSUM 30-day mortality was 1.07, with no significant difference between the observed and predicted values (χ²=4.794; p=0.779). P-POSSUM predicted mortality equally well, with an O:E ratio of 1.10 (χ²=8.905; p=0.350). AUC values (95% CI) were 0.771 (0.634-0.908) and 0.785 (0.651-0.918) for POSSUM and P-POSSUM, respectively.

Conclusion: Both POSSUM and P-POSSUM performed well to predict overall 30-day mortality following intraoperative cardiac arrest in adults undergoing non-cardiac surgery at a university teaching hospital in Korea.

No MeSH data available.


Related in: MedlinePlus