POSSUM is an optimal system for predicting mortality due to colorectal perforation.
OBJECTIVE
The purpose of this study was to determine the most useful predictive scoring system for the postoperative mortality of patients with colorectal perforation using the Acute Physiological and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Physiological and Operative Severity Score for the enUmeration of Mortality (POSSUM).


METHODS
First, the 3 scoring systems were applied to all patients, and the efficacy of these systems was compared between survivors and non-survivors. Second, using receiver operating characteristic (ROC) curve analysis, optimal cut-off values were determined for each system and patients were divided into another two groups (high score group and low score group). Then statistical analyses were performed, respectively.


RESULTS
All scoring systems gave significantly lower scores for survivors than for non-survivors. POSSUM was the most sensitive system for predicting operative mortality (POSSUM: sensitivity 87.5%). Kaplan-Meier analysis and log rank test revealed that there were significant differences between the high score group and the low score group, except for APACHE II. Multivariate logistic regression analysis revealed that only POSSUM was an independent predictor (odds ratio, 0.858; 95% C.I.; 0.736-1,000; p = 0.0498).


CONCLUSIONS
POSSUM is an optimal predictor of mortality following emergency surgery for colorectal perforation.
Ishizuka
Mitsuru
M
Department of Gastroenterological Surgery, Dokkyo University School of Medicine, Tochigi, Japan. mm-ishizuka@umin.ac.jp
Nagata
Hitoshi
H
Takagi
Kazutoshi
K
Horie
Toru
T
Kubota
Keiichi
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000401:mortality*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012002:Rectal Diseases / Q000401:mortality*; D012189:Retrospective Studies; D012720:Severity of Illness Index