Prospective Evaluation of In-hospital Mortality with the P-POSSUM Scoring System in Patients Undergoing Major Digestive Surgery
Background The P-POSSUM score, the most well known of predictive scores for postoperative mortality, requires validation for population and setting. Methods Validation methods included discrimination ( C -index statistic), observed:expected ( O : E ) ratio, calibration with the Hosmer-Lemeshow test,...
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| Veröffentlicht in: | World journal of surgery 2012-10, Vol.36 (10), p.2320-2327 |
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| container_title | World journal of surgery |
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| creator | Merad, Féthi Baron, Gabriel Pasquet, Blandine Hennet, Henry Kohlmann, Gérard Warlin, Fred Desrousseaux, Bruno Fingerhut, Abe Ravaud, Philippe Hay, Jean-Marie |
| description | Background
The P-POSSUM score, the most well known of predictive scores for postoperative mortality, requires validation for population and setting.
Methods
Validation methods included discrimination (
C
-index statistic), observed:expected (
O
:
E
) ratio, calibration with the Hosmer-Lemeshow test, and subgroup analysis (emergency surgery, cancer, age, organs). The study included 3,881 multisite patients undergoing major digestive surgery in France.
Results
Discrimination via the receiver operating characteristic curve was good (
C
-index = 0.87). The overall
O
:
E
ratio was 1 (95% confidence interval ([95 % CI]: 0.88–1.13), and therefore the quality of the surgical performance is within normal ranges. The
O
:
E
ratio, calculated by risk ranges, showed overestimation in the low risk range, especially in the 3 % to 6 % and 6 % to 10 % ranges. Calibration was poor (
p
|
| doi_str_mv | 10.1007/s00268-012-1683-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1111858313</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1111858313</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4226-f647617951d7aa3c55e6097c427b09b1b0824e2737a2bc7c3c1d839ed2ab11603</originalsourceid><addsrcrecordid>eNqFkU9v1DAQxS0EokvhA3BBlrhwMfhPYidHKG0p6qorhRVHy3G8u15l462dtMqJr94JKQghIXwZS_ObN0_zEHrN6HtGqfqQKOWyIJRxwmQhCH2CFiwTnHDBxVO0oEJm8GfiBL1IaU8pU5LK5-iEc8W5VHyBfqxiSEdne3_n8PmdaQfT-9DhsMFXHdlBz_emxcsQofh-xPe-3-F-5_CKrG6qar3ElQ3Rd1tcjal3B-w7vAIN1_UJr7vGxW2YukuzDxF_9luXfu6qhrh1cXyJnm1Mm9yrx3qK1hfn386-kOuby6uzj9fEZuCUbGSmJFNlzhpljLB57iQtFTRVTcua1bTgmeNKKMNrq6ywrClE6RpuasYkFafo3ax7jOF2AA_64JN1bWs6F4akGbwiL-BWgL79C92HIXbgTjNayKzIcs6BYjNl4YApuo0-Rn8wcQRIT-noOR0N6egpHT2ZePOoPNQH1_ye-BUHAOUM3PvWjf9X1N-_Vp8uKJxCwiyfZ9NxisPFP23_y9EDhwiqew</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1086484522</pqid></control><display><type>article</type><title>Prospective Evaluation of In-hospital Mortality with the P-POSSUM Scoring System in Patients Undergoing Major Digestive Surgery</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>SpringerLink Journals</source><creator>Merad, Féthi ; Baron, Gabriel ; Pasquet, Blandine ; Hennet, Henry ; Kohlmann, Gérard ; Warlin, Fred ; Desrousseaux, Bruno ; Fingerhut, Abe ; Ravaud, Philippe ; Hay, Jean-Marie</creator><creatorcontrib>Merad, Féthi ; Baron, Gabriel ; Pasquet, Blandine ; Hennet, Henry ; Kohlmann, Gérard ; Warlin, Fred ; Desrousseaux, Bruno ; Fingerhut, Abe ; Ravaud, Philippe ; Hay, Jean-Marie</creatorcontrib><description>Background
The P-POSSUM score, the most well known of predictive scores for postoperative mortality, requires validation for population and setting.
Methods
Validation methods included discrimination (
C
-index statistic), observed:expected (
O
:
E
) ratio, calibration with the Hosmer-Lemeshow test, and subgroup analysis (emergency surgery, cancer, age, organs). The study included 3,881 multisite patients undergoing major digestive surgery in France.
Results
Discrimination via the receiver operating characteristic curve was good (
C
-index = 0.87). The overall
O
:
E
ratio was 1 (95% confidence interval ([95 % CI]: 0.88–1.13), and therefore the quality of the surgical performance is within normal ranges. The
O
:
E
ratio, calculated by risk ranges, showed overestimation in the low risk range, especially in the 3 % to 6 % and 6 % to 10 % ranges. Calibration was poor (
p
< 0.001). The model deviated from the normal pattern of calibration, with mortality lower than expected in the high-risk range. Subgroup analysis found reasonable to good discrimination of populations (
C
-index ranging from 0.78 to 0.93 except for liver surgery [0.67]) while calibration of individuals remained poor (
p
< 0.001 to 0.02).
Conclusions
Good discrimination, as well as nonsignificant overall
O
:
E
values, makes P-POSSUM a valuable tool when it is used for surgical audit to compare mortality between populations for major digestive surgery. Conversely, poor calibration (goodness-of-fit), especially in subgroup analysis, and underestimation or overestimation of
O
:
E
ratios considerably limits the value of P-POSSUM for prediction of mortality in individuals. Therefore P-POSSUM should not be used to predict outcomes for one particular patient.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-012-1683-0</identifier><identifier>PMID: 22722672</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdominal Surgery ; Cardiac Surgery ; Digestive System Surgical Procedures ; Expect Mortality Rate ; Female ; Forecasting ; General Surgery ; Hospital Mortality ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Operative Severity Score ; Possum Score ; Postoperative Complications - mortality ; Predictive Score ; Prognosis ; Prospective Studies ; Risk Assessment - methods ; Risk Range ; Surgery ; Thoracic Surgery ; Vascular Surgery</subject><ispartof>World journal of surgery, 2012-10, Vol.36 (10), p.2320-2327</ispartof><rights>Société Internationale de Chirurgie 2012</rights><rights>2012 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4226-f647617951d7aa3c55e6097c427b09b1b0824e2737a2bc7c3c1d839ed2ab11603</citedby><cites>FETCH-LOGICAL-c4226-f647617951d7aa3c55e6097c427b09b1b0824e2737a2bc7c3c1d839ed2ab11603</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-012-1683-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-012-1683-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,41464,42533,45550,45551,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22722672$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Merad, Féthi</creatorcontrib><creatorcontrib>Baron, Gabriel</creatorcontrib><creatorcontrib>Pasquet, Blandine</creatorcontrib><creatorcontrib>Hennet, Henry</creatorcontrib><creatorcontrib>Kohlmann, Gérard</creatorcontrib><creatorcontrib>Warlin, Fred</creatorcontrib><creatorcontrib>Desrousseaux, Bruno</creatorcontrib><creatorcontrib>Fingerhut, Abe</creatorcontrib><creatorcontrib>Ravaud, Philippe</creatorcontrib><creatorcontrib>Hay, Jean-Marie</creatorcontrib><title>Prospective Evaluation of In-hospital Mortality with the P-POSSUM Scoring System in Patients Undergoing Major Digestive Surgery</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background
The P-POSSUM score, the most well known of predictive scores for postoperative mortality, requires validation for population and setting.
Methods
Validation methods included discrimination (
C
-index statistic), observed:expected (
O
:
E
) ratio, calibration with the Hosmer-Lemeshow test, and subgroup analysis (emergency surgery, cancer, age, organs). The study included 3,881 multisite patients undergoing major digestive surgery in France.
Results
Discrimination via the receiver operating characteristic curve was good (
C
-index = 0.87). The overall
O
:
E
ratio was 1 (95% confidence interval ([95 % CI]: 0.88–1.13), and therefore the quality of the surgical performance is within normal ranges. The
O
:
E
ratio, calculated by risk ranges, showed overestimation in the low risk range, especially in the 3 % to 6 % and 6 % to 10 % ranges. Calibration was poor (
p
< 0.001). The model deviated from the normal pattern of calibration, with mortality lower than expected in the high-risk range. Subgroup analysis found reasonable to good discrimination of populations (
C
-index ranging from 0.78 to 0.93 except for liver surgery [0.67]) while calibration of individuals remained poor (
p
< 0.001 to 0.02).
Conclusions
Good discrimination, as well as nonsignificant overall
O
:
E
values, makes P-POSSUM a valuable tool when it is used for surgical audit to compare mortality between populations for major digestive surgery. Conversely, poor calibration (goodness-of-fit), especially in subgroup analysis, and underestimation or overestimation of
O
:
E
ratios considerably limits the value of P-POSSUM for prediction of mortality in individuals. Therefore P-POSSUM should not be used to predict outcomes for one particular patient.</description><subject>Abdominal Surgery</subject><subject>Cardiac Surgery</subject><subject>Digestive System Surgical Procedures</subject><subject>Expect Mortality Rate</subject><subject>Female</subject><subject>Forecasting</subject><subject>General Surgery</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Operative Severity Score</subject><subject>Possum Score</subject><subject>Postoperative Complications - mortality</subject><subject>Predictive Score</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Risk Assessment - methods</subject><subject>Risk Range</subject><subject>Surgery</subject><subject>Thoracic Surgery</subject><subject>Vascular Surgery</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkU9v1DAQxS0EokvhA3BBlrhwMfhPYidHKG0p6qorhRVHy3G8u15l462dtMqJr94JKQghIXwZS_ObN0_zEHrN6HtGqfqQKOWyIJRxwmQhCH2CFiwTnHDBxVO0oEJm8GfiBL1IaU8pU5LK5-iEc8W5VHyBfqxiSEdne3_n8PmdaQfT-9DhsMFXHdlBz_emxcsQofh-xPe-3-F-5_CKrG6qar3ElQ3Rd1tcjal3B-w7vAIN1_UJr7vGxW2YukuzDxF_9luXfu6qhrh1cXyJnm1Mm9yrx3qK1hfn386-kOuby6uzj9fEZuCUbGSmJFNlzhpljLB57iQtFTRVTcua1bTgmeNKKMNrq6ywrClE6RpuasYkFafo3ax7jOF2AA_64JN1bWs6F4akGbwiL-BWgL79C92HIXbgTjNayKzIcs6BYjNl4YApuo0-Rn8wcQRIT-noOR0N6egpHT2ZePOoPNQH1_ye-BUHAOUM3PvWjf9X1N-_Vp8uKJxCwiyfZ9NxisPFP23_y9EDhwiqew</recordid><startdate>201210</startdate><enddate>201210</enddate><creator>Merad, Féthi</creator><creator>Baron, Gabriel</creator><creator>Pasquet, Blandine</creator><creator>Hennet, Henry</creator><creator>Kohlmann, Gérard</creator><creator>Warlin, Fred</creator><creator>Desrousseaux, Bruno</creator><creator>Fingerhut, Abe</creator><creator>Ravaud, Philippe</creator><creator>Hay, Jean-Marie</creator><general>Springer-Verlag</general><general>Springer‐Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201210</creationdate><title>Prospective Evaluation of In-hospital Mortality with the P-POSSUM Scoring System in Patients Undergoing Major Digestive Surgery</title><author>Merad, Féthi ; Baron, Gabriel ; Pasquet, Blandine ; Hennet, Henry ; Kohlmann, Gérard ; Warlin, Fred ; Desrousseaux, Bruno ; Fingerhut, Abe ; Ravaud, Philippe ; Hay, Jean-Marie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4226-f647617951d7aa3c55e6097c427b09b1b0824e2737a2bc7c3c1d839ed2ab11603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Abdominal Surgery</topic><topic>Cardiac Surgery</topic><topic>Digestive System Surgical Procedures</topic><topic>Expect Mortality Rate</topic><topic>Female</topic><topic>Forecasting</topic><topic>General Surgery</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Operative Severity Score</topic><topic>Possum Score</topic><topic>Postoperative Complications - mortality</topic><topic>Predictive Score</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Risk Assessment - methods</topic><topic>Risk Range</topic><topic>Surgery</topic><topic>Thoracic Surgery</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Merad, Féthi</creatorcontrib><creatorcontrib>Baron, Gabriel</creatorcontrib><creatorcontrib>Pasquet, Blandine</creatorcontrib><creatorcontrib>Hennet, Henry</creatorcontrib><creatorcontrib>Kohlmann, Gérard</creatorcontrib><creatorcontrib>Warlin, Fred</creatorcontrib><creatorcontrib>Desrousseaux, Bruno</creatorcontrib><creatorcontrib>Fingerhut, Abe</creatorcontrib><creatorcontrib>Ravaud, Philippe</creatorcontrib><creatorcontrib>Hay, Jean-Marie</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Merad, Féthi</au><au>Baron, Gabriel</au><au>Pasquet, Blandine</au><au>Hennet, Henry</au><au>Kohlmann, Gérard</au><au>Warlin, Fred</au><au>Desrousseaux, Bruno</au><au>Fingerhut, Abe</au><au>Ravaud, Philippe</au><au>Hay, Jean-Marie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prospective Evaluation of In-hospital Mortality with the P-POSSUM Scoring System in Patients Undergoing Major Digestive Surgery</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2012-10</date><risdate>2012</risdate><volume>36</volume><issue>10</issue><spage>2320</spage><epage>2327</epage><pages>2320-2327</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><abstract>Background
The P-POSSUM score, the most well known of predictive scores for postoperative mortality, requires validation for population and setting.
Methods
Validation methods included discrimination (
C
-index statistic), observed:expected (
O
:
E
) ratio, calibration with the Hosmer-Lemeshow test, and subgroup analysis (emergency surgery, cancer, age, organs). The study included 3,881 multisite patients undergoing major digestive surgery in France.
Results
Discrimination via the receiver operating characteristic curve was good (
C
-index = 0.87). The overall
O
:
E
ratio was 1 (95% confidence interval ([95 % CI]: 0.88–1.13), and therefore the quality of the surgical performance is within normal ranges. The
O
:
E
ratio, calculated by risk ranges, showed overestimation in the low risk range, especially in the 3 % to 6 % and 6 % to 10 % ranges. Calibration was poor (
p
< 0.001). The model deviated from the normal pattern of calibration, with mortality lower than expected in the high-risk range. Subgroup analysis found reasonable to good discrimination of populations (
C
-index ranging from 0.78 to 0.93 except for liver surgery [0.67]) while calibration of individuals remained poor (
p
< 0.001 to 0.02).
Conclusions
Good discrimination, as well as nonsignificant overall
O
:
E
values, makes P-POSSUM a valuable tool when it is used for surgical audit to compare mortality between populations for major digestive surgery. Conversely, poor calibration (goodness-of-fit), especially in subgroup analysis, and underestimation or overestimation of
O
:
E
ratios considerably limits the value of P-POSSUM for prediction of mortality in individuals. Therefore P-POSSUM should not be used to predict outcomes for one particular patient.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>22722672</pmid><doi>10.1007/s00268-012-1683-0</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0364-2313 |
| ispartof | World journal of surgery, 2012-10, Vol.36 (10), p.2320-2327 |
| issn | 0364-2313 1432-2323 |
| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; SpringerLink Journals |
| subjects | Abdominal Surgery Cardiac Surgery Digestive System Surgical Procedures Expect Mortality Rate Female Forecasting General Surgery Hospital Mortality Humans Male Medicine Medicine & Public Health Middle Aged Operative Severity Score Possum Score Postoperative Complications - mortality Predictive Score Prognosis Prospective Studies Risk Assessment - methods Risk Range Surgery Thoracic Surgery Vascular Surgery |
| title | Prospective Evaluation of In-hospital Mortality with the P-POSSUM Scoring System in Patients Undergoing Major Digestive Surgery |
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