Colorectal surgery outcomes and scoring
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Colorectal Surgery – Outcomes and Scoring. Dermot Burke The General Infirmary at Leeds. Birmingham 37 70 Derby County 38 70 Sunderland 38 67 Preston 37 65 Wolves 38 65 West Bromwich 37 63 Cardiff 38 63 Southampton 38 60 Stoke City 38 58 Colchester 38 53

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Colorectal surgery outcomes and scoring

Colorectal Surgery – Outcomes and Scoring

Dermot Burke

The General Infirmary at Leeds


Colorectal surgery outcomes and scoring

Birmingham37 70

Derby County38 70

Sunderland38 67

Preston37 65

Wolves38 65

West Bromwich37 63

Cardiff38 63

Southampton38 60

Stoke City38 58

Colchester38 53

Crystal Palace37 52

Sheffield Wed38 52

Plymouth36 49

Coventry City38 49

Norwich City37 47

Leicester37 46

Ipswich38 45

Burnley36 41

Hull38 41

Southend38 38

Barnsley37 38

QPR37 37

Luton38 36

Leeds United38 35


Colorectal surgery why score

Colorectal SurgeryWhy Score?

Commissioned analysis of surgical performance by using routine data: lessons from Bristol inquiry.

Spiegelhalter DJ, Aylin P, Best NG, Evans SJW, Murray GD.

J R Statist Soc (Ser A) 2002;165:1-31


Colorectal surgery outcomes and scoring

http://heartsurgery.healthcarecommission.org.uk


Colorectal surgery outcomes and scoring

ASA

  • Fit and well

  • Mild systemic disease

  • Severe, limiting systemic disease

  • Incapacitating systemic disease

  • Moribund


Apache

APACHE

APACHE (1981) 34 physiological variables

APACHE II (1985)12 physiological variables

age and chronic health history.

APACHE III (2001)17 physiologic variables

age and chronic health history

prior treatment location & diagnosis


Apache ii

APACHE II

  • Temperature - core

  • Mean arterial pressure

  • Heart rate

  • Respiratory rate

  • Oxygenation

  • FIO2

  • Arterial pH

  • Serum sodium

  • Serum potassium

  • Serum creatinine

  • Haematocrit

  • White blood cell count


Apache ii1

APACHE II

Developed for use in intensive care setting

Takes no account of surgical insult


What is possum

What is POSSUM?


Colorectal surgery outcomes and scoring

Alien invasion: How the possum became public enemy No 1


What is possum1

What is POSSUM?

Physiological and Operative Severity

Score for the enUmeration of

Morbidity and Mortality


What is possum2

What is POSSUM?

A method of operative risk prediction

that allows for case-mix


What is possum3

What is POSSUM?

18 variables

12 physiological6 operative


Colorectal surgery outcomes and scoring

PhysiologicalOperative

Age OperationCardiac status Number of proceduresECG Blood lossRespiratory status Peritoneal contaminationBP Extent of malignancy

Pulse Elective / emergency GCS HbWCCUreaSodiumPotassium


Possum maths

POSSUM maths

Each factor divided into 1, 2, 3, or 4 levels

weighting of 1, 2, 4 or 8 applied to that level

e.g. blood loss

Amount (ml)

<100

101- 500

501 – 1000

>1000

Level

1

2

3

4

Weighting

1

2

4

8


Original possum equations

Original POSSUM equations

Morbidity

In [R/(1-R)] = -5.91 + (0.16*phys score) + ( 0.19*op sev score)

Mortality

In [R/(1-R)] = -7.04 + (0.13*phys score) + ( 0.16*op sev score)

Minimum risk of mortality = 0.40%


P possum

P-POSSUM

In [R/(1-R)] = -9.06 + (0.169*phys score) + (0.155*op sev score)

Minimum risk of mortality = 0.22%


Cr possum

CR-POSSUM

Physiological (6):

Operative (4):

Age, Cardiac status, BP, Pulse, Hb, Urea

Operation, Peritoneal contamination,

Extent of malignancy, Emergency / Elective

ln[R/(1 − R)] = −9・167 + (0・338*phys score) + (0・308*op sev score)

Tekkis et alBr J Surg 2004, 91: 1174-1182


Cr possum1

CR-POSSUM

Overpredicts young, fit, elective

Underpredictselderly, emergency

Minimum risk of mortality = 0.27%

Tekkis et alBr J Surg 2004, 91: 1174-1182


Validation of cr possum

Validation of CR-POSSUM

Shutt D et al, 2005, ACPGBI


Acpgbi scores

ACPGBI scores

Predictive score for patients with colorectal cancer

(age, ASA, stage, urgency, cancer resection)

Predictive model for patients with malignant

bowel obstruction

(age, ASA, stage, urgency)


Practicalities

Practicalities


Colorectal surgery outcomes and scoring

Arsenal 12 12 0 0 70 2 68 36

Everton 14 10 3 1 32 13 19 31

Charlton Athletic 11 9 1 1 37 13 24 28

Leeds United 11 8 2 1 34 18 16 25

Blackburn Rovers 16 7 8 1 29 29 0 22

Chelsea 11 6 2 3 25 10 15 21

Bristol 11 7 4 0 29 23 6 21

Birmingham City 14 4 6 4 22 21 1 16

Doncaster Rovers 14 4 9 1 17 35 -18 13

Sunderland 17 3 13 1 12 60 -48 10

Cardiff City 16 2 11 3 20 40 -20 9

Fulham 15 1 14 0 9 72 -6 3


Colorectal surgery outcomes and scoring

Man Utd29 23 3 3 66 19 +47 72

Chelsea28 19 6 3 50 19 +31 63

Liverpool29 16 5 8 44 20 +24 53

Arsenal27 15 7 5 50 23 +27 52

Bolton30 14 6 10 34 34 0 48

Everton29 11 10 8 37 26 +11 43

Reading29 13 4 12 43 38 +5 43

Tottenham30 12 7 11 40 43 -3 43

Portsmouth29 11 8 10 36 31 +5 41

Blackburn30 12 5 13 35 39 -4 41

Newcastle29 10 7 12 34 37 -3 37

Middlesborough 29 9 9 11 32 34 -2 36

Aston Villa28 7 12 9 29 34 -5 33

Fulham29 7 12 10 31 44 -13 33

Wigan29 9 5 15 30 44 -14 32

Sheffield Utd29 8 7 14 25 41 -16 31

Man City27 8 6 13 20 33 -13 30

Charlton29 6 6 17 26 49 -23 24

West Ham30 5 6 19 21 50 -29 21

Watford29 3 11 15 18 43 -25 20

Man Utd29 23 3 3 66 19 +47 72

Chelsea28 19 6 3 50 19 +31 63

Liverpool29 16 5 8 44 20 +24 53

Arsenal27 15 7 5 50 23 +27 52

Bolton30 14 6 10 34 34 0 48

Everton29 11 10 8 37 26 +11 43

Reading29 13 4 12 43 38 +5 43

Tottenham30 12 7 11 40 43 -3 43

Portsmouth29 11 8 10 36 31 +5 41

Blackburn30 12 5 13 35 39 -4 41

Newcastle29 10 7 12 34 37 -3 37

Middlesborough 29 9 9 11 32 34 -2 36

Aston Villa28 7 12 9 29 34 -5 33

Fulham29 7 12 10 31 44 -13 33

Wigan29 9 5 15 30 44 -14 32

Sheffield Utd29 8 7 14 25 41 -16 31

Man City27 8 6 13 20 33 -13 30

Charlton29 6 6 17 26 49 -23 24

West Ham30 5 6 19 21 50 -29 21

Watford29 3 11 15 18 43 -25 20


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