This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Elderly POSSUM, a dedicated score for prediction of mortality and morbidity after major colorectal surgery in older patients. BJS 2010; 97: 396-403.

Published: 28th January 2010

Authors: P. Tran Ba Loc, S. Tezenas du Montcel, J. J. Duron, H. Levard, B. Suc, B. Descottes et al.

Background

Several scores have been developed to evaluate surgical unit mortality and morbidity. The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and derivatives use preoperative and intraoperative factors, whereas the Surgical Risk Scale (SRS) and Association Française de Chirurgie (AFC) score use four simple factors. To allow for advanced age in patients undergoing colorectal surgery, a dedicated score—the Elderly (E) POSSUM—has been developed and its accuracy compared with these scores.

Method

From 2002 to 2004, 1186 elderly patients, at least 65 years old, undergoing major colorectal surgery in France were enrolled. Accuracy was assessed by calculating the area under the receiver operating characteristic curve (AUC) (discrimination) and calibration.

Results

The mortality and morbidity rates were 9 and 41 per cent respectively. The E‐POSSUM had both a good discrimination (AUC = 0·86) and good calibration (P = 0·178) in predicting mortality and a reasonable discrimination (AUC = 0·77) and good calibration (P = 0·166) in predicting morbidity. The E‐POSSUM was significantly better at predicting mortality and morbidity than the AFC score (P_c = 0·014 and P_c < 0·001 respectively).

Conclusion

The E‐POSSUM is a good tool for predicting mortality, and the only efficient scoring system for predicting morbidity after major colorectal surgery in the elderly. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Full text