Yonsei Med J.  2015 Sep;56(5):1401-1407. 10.3349/ymj.2015.56.5.1401.

Risk Assessment of Mortality Following Intraoperative Cardiac Arrest Using POSSUM and P-POSSUM in Adults Undergoing Non-Cardiac Surgery

• Kim SH
• Kil HK
• Kim HJ
• Koo BN

• KMID: 2163636
• DOI: http://doi.org/10.3349/ymj.2015.56.5.1401

Abstract

PURPOSE
The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) and its Portsmouth modification (P-POSSUM) are comprehensive assessment methods for evaluating patient and surgical factors widely used to predict 30-day mortality rates. In this retrospective study, we evaluated the usefulness of POSSUM and P-POSSUM in predicting 30-day mortality after intraoperative cardiac arrests in adult patients undergoing non-cardiac surgery.
MATERIALS AND METHODS
Among 190486 patients who underwent anesthesia, 51 experienced intraoperative cardiac arrest as defined in our study protocol. Predicted mortality rates were calculated using POSSUM and P-POSSUM equations and were compared with actual outcomes using exponential and linear analyses. In addition, a receiver operating characteristic curve analysis was undertaken, and area-under-the-curve (AUC) values with confidence intervals (CIs) were calculated for POSSUM and P-POSSUM.
RESULTS
Among the 51 patients with intraoperative cardiac arrest, 32 (62.7%) died within 30 days postoperatively. The overall predicted 30-day mortality rates using POSSUM and P-POSSUM were 65.5% and 57.5%, respectively. The observed-to-predicted (O:E) ratio for the POSSUM 30-day mortality was 1.07, with no significant difference between the observed and predicted values (chi2=4.794; p=0.779). P-POSSUM predicted mortality equally well, with an O:E ratio of 1.10 (chi2=8.905; p=0.350). AUC values (95% CI) were 0.771 (0.634-0.908) and 0.785 (0.651-0.918) for POSSUM and P-POSSUM, respectively.
CONCLUSION
Both POSSUM and P-POSSUM performed well to predict overall 30-day mortality following intraoperative cardiac arrest in adults undergoing non-cardiac surgery at a university teaching hospital in Korea.

Keyword

Cardiac arrest; mortality; surgery

MeSH Terms

Adult
Aged
Female
Heart Arrest/*complications/mortality
Humans
Incidence
Intraoperative Complications/*mortality
Male
Middle Aged
Morbidity
Postoperative Period
ROC Curve
Republic of Korea/epidemiology
Retrospective Studies
Risk Assessment/*methods
*Severity of Illness Index
Surgical Procedures, Operative/*mortality

Figure

• 

  Fig. 1 Receiver operator characteristic curves for the POSSUM, P-POSSUM, and American Society of Anesthesiologists (ASA) grade in the prediction of 30-day mortality after intraoperative cardiac arrest. The areaunder-the-curve values with 95% confidence intervals were 0.771 (0.634-0.908), 0.785 (0.651-0.918), and 0.708 (0.549-0.866) for POSSUM, P-POSSUM, and ASA grade, respectively. POSSUM, Physiological and Operative Severity Score for enUmeration of Mortality and morbidity; P-POSSUM, Portsmouth modification POSSUM.

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