Perioperative outcome of colorectal cancer and validation of CR-POSSUM in a Caribbean country.
OBJECTIVE
To evaluate the risk-adjusted perioperative outcome of colorectal cancer surgery, applying the Colorectal Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (CR-POSSUM).


METHODS
A retrospective chart review of patients who underwent colorectal cancer surgery from 2004 to 2007 was done. Data including demographics and physiological data for CR-POSSUM were recorded. Predicted mortality was calculated; validation of CR-POSSUM was done using Hosmer-Lemeshow goodness-of-fit and Receiver Operating Characteristic (ROC) Curve analyses.


RESULTS
232 patients were studied. The overall mean CR-POSSUM score was 18.3+/-3.8 (SD). Predicted mortality was 7.7%, observed mortality was 6.9% and the standardized mortality ratio was 0.9. 34.4% of patients presented with Duke's Stage C or D and had a higher risk of mortality (Odds Ratio (OR) 3.1, 95% Confidence Intervals (CI) 1.1, 9.1). Emergency surgery was associated with a higher risk of mortality (OR 4.7, 95% CI 1.5, 14.1). CR-POSSUM calibrated well (Hosmer-Lemeshow Chi-square value 4.3; df: 8; p=0.82) and fairly discriminated outcome as shown by the area under the ROC Curve 0.69, (Standard Error: 0.07).


CONCLUSIONS
Perioperative outcome of colorectal surgery in Trinidad and Tobago is comparable to the developed countries as evaluated by the CR-POSSUM. Patients presenting for emergency surgery and those with advanced stages of cancer had higher perioperative mortality.
Hariharan
Seetharaman
S
Department of Clinical Surgical Sciences, The University of the West Indies, St. Augustine, Eric Williams Medical Sciences Complex, Mount Hope, Trinidad and Tobago. uwi.hariharan@gmail.com
Chen
Deryk
D
Ramkissoon
Anushka
A
Taklalsingh
Nicholas
N
Bodkyn
Chevonne
C
Cupidore
Ryon
R
Ramdin
Amit
A
Ramsaroop
Akash
A
Sinanan
Videsh
V
Teelucksingh
Siara
S
Verma
Sumit
S
D000368:Aged; D017691:Caribbean Region; D002423:Cause of Death; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D003107:Colorectal Surgery / Q000401:mortality*; D016001:Confidence Intervals; D003906:Developing Countries; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011184:Postoperative Period; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome