Unreasonable expectations in emergency colorectal cancer surgery.
OBJECTIVE
The recently published ACPGBI colorectal cancer (ACPGBI CRC) scoring system for predicting operative mortality has been suggested as an instrument to improve patient consent procedures and to compare results between centres. This study compares the results of a surgical unit against the standards set by the ACPGBI colorectal cancer model and for emergency surgery, against the p-POSSUM instrument.


METHODS
Data for the ACPGBI CRC model were collected prospectively through 2003 at the Leicester Royal Infirmary. Additional data needed for the p-POSSUM was retrospectively collected from case records. The actual mortality was compared with that predicted by the models.


RESULTS
Seventy-two colorectal cancer operations were performed during the study period. The observed operative mortality in elective cases was lower, and in emergency cases higher, than predicted by the ACPGBI CRC model. With emergency cases the predicted mortality using P-POSSUM was significantly higher than that using the ACPGBI CRC model, particularly in the presence of faecal contamination.


CONCLUSIONS
The ACPGBI CRC model may be accurate for elective cases, but appears to significantly underestimate predicted mortality in the emergency setting, both actual and predicted by p-POSSUM. This may be due to a failure to incorporate adequate weighting for faecal peritonitis and the associated systemic insult into the ACPGBI model.
Metcalfe
M S
MS
Department of Surgery, Leicester Royal Infirmary, Leicester, UK. matthew.metcalfe@adelaide.edu.au
Norwood
M G A
MG
Miller
A S
AS
Hemingway
D
D
D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery; D016015:Logistic Models; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D006113:United Kingdom / Q000453:epidemiology