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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


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

Crystal Palace 37 52

Sheffield Wed 38 52

Plymouth 36 49

Coventry City 38 49

Norwich City 37 47

Leicester 37 46

Ipswich 38 45

Burnley 36 41

Hull 38 41

Southend 38 38

Barnsley 37 38

QPR 37 37

Luton 38 36

Leeds United 38 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



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 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 physiological 6 operative


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 al Br J Surg 2004, 91: 1174-1182


Cr possum1
CR-POSSUM

Overpredicts young, fit, elective

Underpredicts elderly, emergency

Minimum risk of mortality = 0.27%

Tekkis et al Br 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)



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


Man Utd 29 23 3 3 66 19 +47 72

Chelsea 28 19 6 3 50 19 +31 63

Liverpool 29 16 5 8 44 20 +24 53

Arsenal 27 15 7 5 50 23 +27 52

Bolton 30 14 6 10 34 34 0 48

Everton 29 11 10 8 37 26 +11 43

Reading 29 13 4 12 43 38 +5 43

Tottenham 30 12 7 11 40 43 -3 43

Portsmouth 29 11 8 10 36 31 +5 41

Blackburn 30 12 5 13 35 39 -4 41

Newcastle 29 10 7 12 34 37 -3 37

Middlesborough 29 9 9 11 32 34 -2 36

Aston Villa 28 7 12 9 29 34 -5 33

Fulham 29 7 12 10 31 44 -13 33

Wigan 29 9 5 15 30 44 -14 32

Sheffield Utd 29 8 7 14 25 41 -16 31

Man City 27 8 6 13 20 33 -13 30

Charlton 29 6 6 17 26 49 -23 24

West Ham 30 5 6 19 21 50 -29 21

Watford 29 3 11 15 18 43 -25 20

Man Utd 29 23 3 3 66 19 +47 72

Chelsea 28 19 6 3 50 19 +31 63

Liverpool 29 16 5 8 44 20 +24 53

Arsenal 27 15 7 5 50 23 +27 52

Bolton 30 14 6 10 34 34 0 48

Everton 29 11 10 8 37 26 +11 43

Reading 29 13 4 12 43 38 +5 43

Tottenham 30 12 7 11 40 43 -3 43

Portsmouth 29 11 8 10 36 31 +5 41

Blackburn 30 12 5 13 35 39 -4 41

Newcastle 29 10 7 12 34 37 -3 37

Middlesborough 29 9 9 11 32 34 -2 36

Aston Villa 28 7 12 9 29 34 -5 33

Fulham 29 7 12 10 31 44 -13 33

Wigan 29 9 5 15 30 44 -14 32

Sheffield Utd 29 8 7 14 25 41 -16 31

Man City 27 8 6 13 20 33 -13 30

Charlton 29 6 6 17 26 49 -23 24

West Ham 30 5 6 19 21 50 -29 21

Watford 29 3 11 15 18 43 -25 20


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