title: Preoperative risk evaluation of postoperative morbidity in IBD patients--impact of the POSSUM score.
abstract: BACKGROUND
  The aim of this study was to assess the morbidity and mortality of patients undergoing surgery for inflammatory bowel disease (IBD) with special focus of the predictive value of the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) scoring system for preoperative risk adjustment of postoperative morbidity.
  
  
  METHODS
  The operative notes and hospital files of 191 patients with IBD were analyzed. The POSSUM scoring system was used to predict morbidity rates after surgery. The physiological sub-score of the POSSUM score was analyzed with regard to its ability to predict postoperative complications.
  
  
  RESULTS
  The overall complication rate was 27.7%, and the mortality was 0.5%. The morbidity rate predicted by POSSUM was 28.4% and the mortality rate 7.2%. The mean POSSUM-phys sub-score in patients without the major complications (anastomotic leakages, peritonitis, bleeding) was significant lower compared to patients with at least one of these complications (14.7 vs. 18.6; p < 0.001). Regarding the major complications separately, there were significant differences in the POSSUM-phys scores in patients developing a sepsis (14.1 vs. 23.4; p < 0.001) and/or a peritonitis (14.8 vs. 19.2; p = 0.05), whereas patients developing an anastomotic leakage/suture dehiscence or a postoperative bleeding did not differ significantly.
  
  
  CONCLUSIONS
  POSSUM was an accurate predictor of morbidity in IBD patients and overpredicted mortality. The POSSUM-phys score is a promising instrument for identifying patients at increased risk of developing major postoperative complications after surgery for IBD.
authors.affiliation: Department of General Surgery and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel Arnold-Heller-Str. 7, 24105 Kiel, Germany. jan-hendrik.egberts@uksh-kiel.de
authors.forename: Jan-Hendrik
authors.initials: JH
authors.lastname: Egberts
authors.forename: Antje
authors.initials: A
authors.lastname: Stroeh
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Alkatout
authors.forename: Freya A
authors.initials: FA
authors.lastname: Goumas
authors.forename: Phillipp A
authors.initials: PA
authors.lastname: Brand
authors.forename: Clemens
authors.initials: C
authors.lastname: Schafmayer
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
authors.forename: Bodo
authors.initials: B
authors.lastname: Schniewind
mesh_terms: D000328:Adult; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care; D018570:Risk Assessment