BACKGROUND: The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) criteria have been used to assess surgical risk in patients in the UK. The aim was to determine how applicable these criteria are to patients undergoing surgery in the USA. METHODS: Two cohorts of patients undergoing major non-cardiac surgery were followed prospectively in the USA (n = 1056) and the UK (n = 1539). Each patient was assigned a risk score for preoperative physiological status and operative severity using the established POSSUM criteria. Death in hospital was the primary outcome measure. For each patient a predicted risk of death was calculated from Portsmouth POSSUM (P-POSSUM) methodology using an established equation. The relationships between predicted and observed mortality rates in each cohort were investigated by means of multivariate logistic regression. RESULTS: Within each cohort, an increase in risk estimated by P-POSSUM predicted an increase in observed mortality rate (P < 0.001). For any given risk level, however, mortality rates were significantly higher in the UK cohort than in the US cohort (odds ratio 4.50 (95 per cent confidence interval 2.81 to 7.19); Z = 6.25, P < 0.001). CONCLUSION: An increase in predicted risk, based on the P-POSSUM methodology, was associated with a higher mortality rate in patients from both countries. However, risk-adjusted mortality rates following major surgery were four times higher in the UK cohort. These marked differences warrant validation in a larger number of centres. Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
BACKGROUND: The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) criteria have been used to assess surgical risk in patients in the UK. The aim was to determine how applicable these criteria are to patients undergoing surgery in the USA. METHODS: Two cohorts of patients undergoing major non-cardiac surgery were followed prospectively in the USA (n = 1056) and the UK (n = 1539). Each patient was assigned a risk score for preoperative physiological status and operative severity using the established POSSUM criteria. Death in hospital was the primary outcome measure. For each patient a predicted risk of death was calculated from Portsmouth POSSUM (P-POSSUM) methodology using an established equation. The relationships between predicted and observed mortality rates in each cohort were investigated by means of multivariate logistic regression. RESULTS: Within each cohort, an increase in risk estimated by P-POSSUM predicted an increase in observed mortality rate (P < 0.001). For any given risk level, however, mortality rates were significantly higher in the UK cohort than in the US cohort (odds ratio 4.50 (95 per cent confidence interval 2.81 to 7.19); Z = 6.25, P < 0.001). CONCLUSION: An increase in predicted risk, based on the P-POSSUM methodology, was associated with a higher mortality rate in patients from both countries. However, risk-adjusted mortality rates following major surgery were four times higher in the UK cohort. These marked differences warrant validation in a larger number of centres. Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Authors: Féthi Merad; Gabriel Baron; Blandine Pasquet; Henry Hennet; Gérard Kohlmann; Fred Warlin; Bruno Desrousseaux; Abe Fingerhut; Philippe Ravaud; Jean-Marie Hay Journal: World J Surg Date: 2012-10 Impact factor: 3.352
Authors: Hemant M Kocher; Paris P Tekkis; Palepu Gopal; Ameet G Patel; Simon Cottam; Irving S Benjamin Journal: World J Gastroenterol Date: 2005-04-28 Impact factor: 5.742
Authors: Birendra Kumar Sah; Zheng Gang Zhu; Ming Min Chen; Ming Xiang; Jun Chen; Min Yan; Yan Zhen Lin Journal: Langenbecks Arch Surg Date: 2008-06-27 Impact factor: 3.445
Authors: S M M de Castro; J T Houwert; S M Lagarde; J B Reitsma; O R C Busch; T M van Gulik; H Obertop; D J Gouma Journal: World J Surg Date: 2009-07 Impact factor: 3.352