Mortality and surgical risk assessment among the extreme old undergoing emergency surgery.
BACKGROUND
Although longevity is becoming frequent, there are no scores to assess nonagenarians undergoing emergency surgery. The aim of this prospective observational study was to determine 30-day mortality and the individual performance of the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM) and other scores in predicting their risk for death.


METHODS
A total of 126 patients were included (2006-2011) and followed for 30 days. Patients risk for death was calculated using different scores. The accuracy of each score was assessed with exponential and linear methods and using the area under the receiver operating characteristic curve.


RESULTS
Overall mortality was 34.9%. The POSSUM, with a modification in the age category, had an area under the curve of .71 and ratios of observed to predicted deaths of 1.07 and 1.22, respectively, in the linear and exponential analysis.


CONCLUSIONS
In a population with as high a risk as nonagenarians, the age-modified POSSUM proved accurate to audit surgery and assess mortality risk.
Vall d'Hebron University Hospital, General Area, Department of Anaesthesia, Universitat Autonoma de Barcelona, Barcelona, Spain. pelavski@yahoo.es
Andrés D
AD
Pelavski
Albert
A
Lacasta
Marcos
M
de Miguel
Maria I
MI
Rochera
Marius
M
Roca
D000369:Aged, 80 and over; D004630:Emergencies; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D013514:Surgical Procedures, Operative / Q000401:mortality*