Validity of the orthopedic POSSUM scoring system for the assessment of postoperative mortality in patients with pressure ulcers.
In the treatment of pressure ulcers, assessment of systemic problems is an important yet difficult step in selecting either conservative or surgical therapeutic intervention. The surgical auditing system called the Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity (POSSUM) and its orthopedic version (O-POSSUM), which gives a predictive mortality rate for the first 30 postoperative days, may be useful for assessing systemic status, but have yet to be sufficiently validated for patients with pressure ulcers. To assess the validity of POSSUM and O-POSSUM, 71 procedures on 50 cases were retrospectively statistically analyzed using receiver operating characteristic curves and goodness-of-fitness testing with the Hosmer-Lemeshow chi(2) test for logistic regression modeling. POSSUM and O-POSSUM showed satisfactory discriminatory power in receiver operating curve analysis. The validity of the values obtained by POSSUM and O-POSSUM was also confirmed. O-POSSUM was superior to POSSUM in both analyses. O-POSSUM is useful in assessing the systemic status of patients with pressure ulcers. Some patients with pressure ulcers show extreme systemic conditions. Assessment of systemic status with O-POSSUM contributes to daily clinical practice and future studies of treatments for pressure ulcers.
Kurita
Masakazu
M
Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo 181-8611, Japan. masakazukurita@aol.com
Ichioka
Shigeru
S
Tanaka
Yukari
Y
Umekawa
Kouhei
K
Oshima
Yoshio
Y
Ohura
Norihiko
N
Kinoshita
Mikio
M
Harii
Kiyonori
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D019637:Orthopedic Procedures / Q000379:methods*; D011184:Postoperative Period; D003668:Pressure Ulcer / Q000401:mortality* / Q000601:surgery; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D055815:Young Adult