Examination of prognostic factors in patients undergoing surgery for colorectal perforation: a case controlled study.
OBJECTIVE
To determine if the POSSUM, SOFA, MPI, and SAS scores provide a better measure of severity for patients with prognostic factors undergoing surgery for colorectal perforation.


METHODS
Fifty-nine patients who underwent surgery between 1996 and 2012.


METHODS
We retrospectively reviewed background factors, blood and physiological test results, and intraoperative findings of patients who survived and those who died. We also compared the POSSUM, SOFA, MPI, and SAS scores. Multivariate analysis was performed for factors that were significant by univariate analysis, and selected factors were used to produce a predictive prognostic model.


RESULTS
Univariate analysis revealed significant differences in age, anticoagulant/steroid administration, serum creatinine level, PF ratio, base excess (BE), chest radiography, pulse rate, and severity of peritoneal soiling. Age, serum creatinine level, pulse rate, and severity of peritoneal soiling were selected for multivariate analysis; only pulse rate was significantly different. There were significant differences between the two groups in POSSUM PS, OSS, SOFA, and MPI scores, and a comparison in terms of the ROC curve showed that our model had the highest peak; the area under the curve was 94.8% compared with 70-80% for the other systems, suggesting that our model is better than those systems.


CONCLUSIONS
POSSUM and SOFA are valid methods of evaluating risk from colorectal perforation, but our study revealed addition risk factors: (1) the PF ratio and BE, which are not included in POSSUM; (2) the pulse rate and severity of peritonitis, which are not included in SOFA; and (3) anticoagulant/steroid hormone administration.
Department of Gastrointestinal Surgery, Tokyo Medical University Hachiouji Medical Center, 1163 Tate-machi, Hachiouji, Tokyo 193-0998, Japan. Electronic address: ts3350@yahoo.co.jp.
Tetsuo
T
Sumi
Third Department of Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjyuku, Shinjyuku-ku, Tokyo 160-0023, Japan.
Kenji
K
Katsumata
Department of Gastrointestinal Surgery, Tokyo Medical University Hachiouji Medical Center, 1163 Tate-machi, Hachiouji, Tokyo 193-0998, Japan.
So
S
Katayanagi
Department of Gastrointestinal Surgery, Tokyo Medical University Hachiouji Medical Center, 1163 Tate-machi, Hachiouji, Tokyo 193-0998, Japan.
Yuuki
Y
Nakamura
Department of Gastrointestinal Surgery, Tokyo Medical University Hachiouji Medical Center, 1163 Tate-machi, Hachiouji, Tokyo 193-0998, Japan.
Tomohisa
T
Nomura
Department of Gastrointestinal Surgery, Tokyo Medical University Hachiouji Medical Center, 1163 Tate-machi, Hachiouji, Tokyo 193-0998, Japan.
Kiminori
K
Takano
Third Department of Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjyuku, Shinjyuku-ku, Tokyo 160-0023, Japan.
Kazuhiko
K
Kasuya
Department of Gastrointestinal Surgery, Tokyo Medical University Hachiouji Medical Center, 1163 Tate-machi, Hachiouji, Tokyo 193-0998, Japan.
Motohide
M
Shimazu
Third Department of Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjyuku, Shinjyuku-ku, Tokyo 160-0023, Japan.
Akihiko
A
Tsuchida
D000328:Adult; D000368:Aged; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000209:etiology; D011379:Prognosis; D012372:ROC Curve; D012002:Rectal Diseases / Q000601:surgery*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index
Colorectal perforation; Prognostic factor; Prognostic scoring system