Predicting postoperative morbidity by clinical assessment

Markus, Peter M.; Martell, J.; Leister, I.; Horstmann, O.; Brinker, Jeffrey A.; Becker, H.

doi:10.1002/bjs.4608

Cited by 125 publications

(86 citation statements)

References 11 publications

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“…4 The number of risk factors present in patients with (light bars, mean 5.8 SD 2.2) and without (dark bars, mean 4.6 SD 2.2) anastomotic leakage are depicted (p=0.02). Error bars represent standard deviation in large surgical interventions, comparing clinical judgement and prediction by POSSUM scores to actual outcome [14]. In this study, the surgeons' general clinical judgement was more accurate than POSSUM scores in upper gastrointestinal and hepatobiliary procedures but not in colorectal procedures.…”

Section: Discussionmentioning

confidence: 67%

“…Based on this striking finding, they concluded that surgical performance during the operation is an important predictor of post-operative complications. Considering this latter study [12], it might be assumed that the surgeon is able to reliably predict the risk of anastomotic leakage, but as mentioned by Markus et al [14], they found the surgeons' risk estimation after completion of the operation not to be a good predictor of post-operative complications, particularly in colorectal surgery. This finding is emphasized by our study.…”

Section: Discussionmentioning

confidence: 83%

“…Three studies have shown that the surgeons' global assessment is a predictor of complications in general [12,13] and is even more accurate than risk assessment by Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) scores [14]. Until now, no studies have been published evaluating the surgeons' clinical judgement on the risk of anastomotic leakage.…”

Section: Introductionmentioning

confidence: 99%

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Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Karliczek

Harlaar

Zeebregts

et al. 2009

Int J Colorectal Dis

392

239

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Background The dramatic clinical consequences of anastomotic leakage in gastrointestinal surgery can be reduced by a diverting stoma or drainage of the peri-anastomotic area. Currently, the surgeons' clinical judgement is of major importance in decision making, but reliable data of the diagnostic accuracy are lacking. In this prospective clinical study, the surgeons' predictive accuracy for anastomotic leakage was evaluated. Materials and methods In 191 patients undergoing colorectal resection with anastomosis, the risk for anastomotic leakage was determined by the surgeon on the basis of a visual analogue scale (VAS). This risk assessment was compared to the actual occurrence of anastomotic leakage post-operatively. Results A total of 26 (13.6%) patients showed anastomotic leakage. The surgeons' median predicted leakage rate was 7.1% in anastomoses >15 cm from the anal verge and 9.5% ≤15 cm (sensitivity 38/62%, specificity 46/52%). Diagnostic accuracy was not influenced by the surgeons' training level (VAS score, surgeons 7.8% vs assistant surgeons 8.5%, p=0.96, sensitivity 41% vs 44%, specificity 59% vs 48%, p=0.20). Conclusion The surgeons' clinical risk assessment appeared to have a low predictive value for anastomotic leakage in gastrointestinal surgery. The low a priori risk of anastomotic leakage of 14% resulted in a low post-test odds (11%) of correct prediction of anastomotic leakage. This warrants the ongoing search for a better diagnostic test of anastomotic leakage to prevent morbidity and mortality.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Karliczek

Harlaar

Zeebregts

et al. 2009

Int J Colorectal Dis

392

239

View full text Add to dashboard Cite

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“…Predictive value of POSSUM to morbidity was affected by the type of surgery and the sample size of studies. [7] Compared with POSSUM, P-POSSUM was more accurate for predicting postoperative mortality. [8] Therefore, P-POSSUM scoring system designed and used successfully for high risk group of patients.…”

Section: Discussionmentioning

confidence: 97%

The Analysis of Scoring Systems Predicting Mortality in Geriatric Emergency Abdominal Surgery

Ozban

Birsen

Uzel Senel

et al. 2015

Ulus Travma Acil Cerrahi Derg

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“…[18] A number of risk-adjusted scoring systems have been developed to suit surgical audit, in case of emergency surgery, the POSSUM system appears to be of value as all the parameters are usually completed. [19] Hence in our study we assessed the validity of POSSUM score in 104 emergency midline laparotomy patients in Indian scenario. Since this study includes only the emergency cases, we were unable to normalise all the correctable physiological variables prior to surgery.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of POSSUM Score for Outcome Prediction in Patients Undergoing Emergency Laparotomy

Rana¹,

Singh²,

Gupta³

et al. 2018

AIMDR

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Background: Emergency Laparotomy is one of the most common surgical procedures performed in Surgical Emergencies, which leads to significant mortality and morbidity. The aim of this study was to evaluate the patients undergoing emergency midline laparotomy, utilizing POSSUM scoring system to help to predict morbidity and mortality in patients, and assuring improved management in present setup. Methods: Total 104 consecutive patients underwent emergency midline laparotomy over a period of two years were included in this prospective study. Surgical outcome was assessed and compared with POSSUM scoring system. The relevant data was recorded on predesigned proforma and analysed. Results: We studied 104 emergency midline laparotomy patients, which resulted in 15 deaths (14.4% Mortality rate). On applying POSSUM, we found that the expected number of deaths for our study group was 24 (O: E= 0.63), relationship was statistically significant. Observed morbidity was 61 (58.65%). On applying POSSUM we found that the expected number of morbidity for our study group was 65 (O: E= 0.93), relationship was statistically significant. Conclusion:The present study validates that the POSSUM is an accurate scoring system for predicting postoperative adverse outcome among patients undergoing major general surgeries in present setup.

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Predicting postoperative morbidity by clinical assessment

Abstract: The surgeon's gut-feeling is a good predictor of postoperative outcome, especially after elective surgery. (P)-POSSUM overpredicted morbidity and mortality in this series of major gastrointestinal and hepatobiliary operations.

Cited by 125 publications

References 11 publications

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

The Analysis of Scoring Systems Predicting Mortality in Geriatric Emergency Abdominal Surgery

Evaluation of POSSUM Score for Outcome Prediction in Patients Undergoing Emergency Laparotomy

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