Evaluation of the correlation between pre-anaesthetic P-POSSUM score, ultrasound muscle assessment and frailty index on perioperative outcome - An observational trial

Abstract

Background and aims: Bedside muscle ultrasonography has emerged as a clinical tool for sarcopenia and perioperative outcomes. We aimed to find a correlation between the pre-anaesthetic Portsmouth Physiological and Operative Severity score for the enumeration of mortality and morbidity (P-POSSUM), Fried Frailty Phenotype (FrFP) and ultrasound-guided (USG) muscle cross-sectional area (CSA) with morbidity and mortality outcomes in elective surgeries.

Methods: This prospective observational trial included 150 patients aged 18-80 years undergoing low-risk (n = 50), intermediate-risk (n = 50), and high-risk (n = 50) surgeries. Preoperative P-POSSUM scores, USG CSA of psoas major and rectus femoris muscles and FrFP were recorded. Postoperative outcomes on days 1, 2 and 3 and then until patient discharge were observed. A P value < 0.05 was considered statistically significant.

Results: Demographics of patients were similar in age, gender, weight, body mass index and pre-frail status. A strong correlation coefficient was observed for physiological score, operative severity score, CSA of psoas major and CSA of rectus femoris. A weak strength correlation coefficient was observed between FrFP and CSA of psoas major, regarding 30-day morbidity and mortality. The area under the curve (AUC) - 0.74 for psoas major had moderate predictive ability, and AUC-0.84 for rectus femoris showed a strong predictive ability against 30-day mortality in high-risk surgeries. The Hosmer-Lemeshow goodness-of-fit test analysis revealed a mortality ratio of 0.98.

Conclusion: P-POSSUM and CSA of psoas major and rectus femoris had a statistically significant positive correlation to predict perioperative 30-day mortality in survivor versus non-survivor patients of high-risk surgeries.

Keywords: Frailty scores; Portsmouth Physiological and Operative Severity score for the enumeration of mortality and morbidity; morbidity; mortality; muscle ultrasound; postoperative outcomes.

Figure 1

ROC of P-POSSUM against 30-day mortality in low-risk (a), intermediate-risk (b) and high-risk (c) surgeries. ROC of frailty scores against 30-day mortality in low-risk (d), intermediate-risk (e) and high-risk (f) surgeries. ROC of cross-sectional area of psoas major and rectus femoris muscles against 30-day mortality in low-risk (g), intermediate-risk (h) and high-risk (i) surgeries. P-POSSUM=portsmouth physiological and operative severity score for the enumeration of mortality and morbidity, ROC=receiver operating characteristic

Figure 2

ROC of P-POSSUM, frailty and ultrasound-guided CSA of psoas major and rectus femoris against 30-day mortality in all 150 patients (a) Survivor patients (n = 30) of high-risk group (b) Mortality patients (n = 20) of high-risk group (c). Kaplan–Meier survivor analysis in 150 patients undergoing low, intermediate and high-risk surgeries (d) CSA=cross-sectional area, P-POSSUM=portsmouth physiological and operative severity score for the enumeration of mortality and morbidity, ROC=receiver operating characteristic