Risk-adjusted prediction of operative mortality in oesophagogastric surgery with O-POSSUM

• Published in: British journal of surgery 2004-03, Vol.91 (3), p.288-295
• Main Authors: Tekkis, P. P., McCulloch, P., Poloniecki, J. D., Prytherch, D. R., Kessaris, N., Steger, A. C.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Esophageal Diseases - mortality; Esophageal Diseases - surgery; Female; General aspects; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Postoperative Complications - mortality; Regression Analysis; Risk Assessment - methods; Risk Factors; Severity of Illness Index; Stomach Diseases - mortality; Stomach Diseases - surgery
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.4414

Introduction: The present study was designed to develop a dedicated oesophagogastric model for the prediction of risk‐adjusted postoperative mortality in upper gastrointestinal surgery (O‐POSSUM). Methods: Using 1042 patients undergoing oesophageal (n = 538) or gastric (n = 504) surgery between 1994 and 2000 the Portsmouth predictor equation for mortality (P‐POSSUM) scoring system was compared with a standard logistic regression O‐POSSUM model and a multilevel O‐POSSUM model using the following independent factors: age, physiological status, mode of surgery, type of surgery and histological stage. Results: The overall mortality rate was 12·0 per cent (elective mortality rate 9·4 per cent and emergency mortality rate 26·9 per cent). P‐POSSUM overpredicted mortality (14·5 per cent), particularly in the elective group of patients. The multilevel model offered higher discrimination than the single‐level O‐POSSUM and P‐POSSUM models (area under receiver–operator characteristic curve 79·7 versus 74·6 and 74·3 per cent). When observed to expected outcomes were evaluated, the multilevel O‐POSSUM model was found to offer better calibration (Hosmer–Lemeshow χ2 statistic 10·15 versus 10·52 and 28·80). Conclusion: The multilevel O‐POSSUM model provided an accurate risk‐adjusted prediction of death from oesophageal and gastric surgery for individual patients. In conjunction with a multidisciplinary approach to patient management, the model may be used in everyday practice for perioperative counselling of patients and their carers. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. A useful system for comparative audit