title: Colorectal surgical mortality and morbidity in elderly patients: comparison of POSSUM, P-POSSUM, CR-POSSUM, and CR-BHOM.
abstract: OBJECTIVE
  This study aims to compare the predictive value of POSSUM, P-POSSUM, CR-POSSUM and CR-BHOM in colorectal surgical mortality and morbidity in patients over 80 years old.
  
  
  METHODS
  This is a retrospective observational longitudinal study. A total of 991 patients who underwent major colorectal surgery between 2008 and 2012 in a secondary hospital in Portugal were screened, and 204 who were over 80 years old were included. Subgroup analysis was performed for malignant/benign disease and emergent/elective surgery. The main outcome measure was 30-day postoperative mortality and morbidity with Clavien-Dindo classification ≥ 2.
  
  
  RESULTS
  Of the 204 patients included in this study, 155 had malignant disease, and 65 underwent emergent procedures. Overall average age was 84.3 ± 3.9 years (range 80-100). Overall surgical mortality and morbidity were 18.6% (n = 38) and 52.4% (n = 87), respectively. Expected mortality followed the order P-POSSUM<CR-POSSUM<CR-BHOM (p < 0.001), and expected morbidity followed the order POSSUM<CR-BHOM (p < 0.001) in all groups. All scores were higher in the emergent surgery group compared with elective surgery (p < 0.05). All scores had sensitivity below 60%. Physiology scores were higher among patients with surgical mortality (p < 0.05), with no differences in operative scores.
  
  
  CONCLUSIONS
  In our population, CR-POSSUM was the best predictor of surgical mortality. POSSUM and P-POSSUM underestimated surgical mortality and morbidity, and CR-BHOM overestimated surgical mortality, being however the best predictor of morbidity. Nevertheless, none of the scores showed sufficient discriminatory power to have clinical application value. Moreover, our results suggest that, in elderly patients, it is the patient's health status and not the type of surgery that is mainly responsible for the surgical outcome.
authors.affiliation: B Surgery Department, Hospital Prof. Doutor Fernando Fonseca, Estrada IC-19, 2720-276, Amadora, Portugal, apspgomes@gmail.com.
authors.forename: António
authors.initials: A
authors.lastname: Gomes
authors.forename: Ricardo
authors.initials: R
authors.lastname: Rocha
authors.forename: Rui
authors.initials: R
authors.lastname: Marinho
authors.forename: Marta
authors.initials: M
authors.lastname: Sousa
authors.forename: Nuno
authors.initials: N
authors.lastname: Pignatelli
authors.forename: Carla
authors.initials: C
authors.lastname: Carneiro
authors.forename: Vitor
authors.initials: V
authors.lastname: Nunes
mesh_terms: D000369:Aged, 80 and over; D003107:Colorectal Surgery / Q000401:mortality*; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009017:Morbidity; D012189:Retrospective Studies; D012680:Sensitivity and Specificity