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. 2019 Jul;7(3):223-231.
doi: 10.29252/beat-070303.

Prognostic Value of P-POSSUM and Osteopenia for Predicting Mortality After Emergency Laparotomy in Geriatric Patients

Rebecka Ah  1 , M B BChir  1   2 , Yang Cao  3 , Hakan Geijer  4 , Kardo Taha  5 , Sahar Pourhossein-Sarmeh  5 , Peep Talving  6   7 , Olle Ljungqvist  2 , Shahin Mohseni  2   5
Affiliations

Prognostic Value of P-POSSUM and Osteopenia for Predicting Mortality After Emergency Laparotomy in Geriatric Patients

Rebecka Ah et al. Bull Emerg Trauma. 2019 Jul.

Abstract

Objective: To evaluate the Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) in comparison with other risk factors for mortality including osteopenia as an indicator for frailty in geriatric patients subjected to emergency laparotomy.

Methods: All geriatric patients (≥65 years) undergoing emergency laparotomy at a single university hospital between 1/2015 and 12/2016 were included in this cohort study. Demographics and outcomes were retrospectively collected from medical records. Association between prognostic markers and 30-day mortality was assessed using Poisson and backward stepwise regression models. Prognostic value was assessed using receiver operating characteristic (ROC) curves.

Results: 209 patients were included with a mean age of 76 ± 7.3 years. American Society of Anesthesiologists (ASA) classification, age, indication and type of surgery, hypotension, transfusion requirement and current malignancy proved to be statistically significant predictors of 30-day mortality. P-POSSUM mortality was statistically significant in the backward stepwise regression (incidence rate ratio=1.58, 95% CI: 1.16-2.15, p=0.004) while osteopenia was not. P-POSSUM had poor prognostic value for 30-day mortality with an area under the ROC curve (AUC) of 0.59. The prognostic value of P-POSSUM improved significantly when adjusting for patient covariates (AUC=0.83).

Conclusion: P-POSSUM and osteopenia alone hardly predict 30-day mortality in geriatric patients following emergency laparotomy. P-POSSUM adjusted for other patient covariates improves the prediction.

Keywords: Emergency Laparotomy; Emergency Surgery; Geriatric; Mortality.

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Conflict of interest statement

The authors declare that they have no conflict of interest and have no funding sources to declare.

Figures

Fig. 1
Fig. 1
Area under ROC curves
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References

    1. In: SCB. Medellivslängden i Sverige. [[Accessed: 19NOV 2018]]. Available from: https://www.scb.se/hitta-statistik/sverige-i-siffror/manniskorna-i-sveri....
    1. Torrance AD, Powell SL, Griffiths EA. Emergency surgery in the elderly: challenges and solutions. Open Access Emerg Med. 2015;7:55–68. - PMC - PubMed
    1. Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ. Participants in the VA National Surgical Quality Improvement Program Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242(3):326–41; discussion 341-3. - PMC - PubMed
    1. Moonesinghe SR, Harris S, Mythen MG, Rowan KM, Haddad FS, Emberton M, et al. Survival after postoperative morbidity: a longitudinal observational cohort study. Br J Anaesth. 2014;113(6):977–84. - PMC - PubMed
    1. Kuhne CA, Ruchholtz S, Kaiser GM, Nast-Kolb D. Working Group on Multiple Trauma of the German Society of Trauma Mortality in severely injured elderly trauma patients--when does age become a risk factor? World J Surg. 2005;29(11):1476–82. - PubMed

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