title: aLicante sUrgical Community Emergencies New Tool for the enUmeration of Morbidities: a simplified auditing tool for community-acquired gastrointestinal surgical emergencies.
abstract: BACKGROUND
  In a previous study, we found that Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) overpredicts morbidity risk in emergency gastrointestinal surgery. Our aim was to find a POSSUM equation adjustment.
  
  
  METHODS
  A prospective observational study was performed on 2,361 patients presenting with a community-acquired gastrointestinal surgical emergency. The first 1,000 surgeries constituted the development cohort, the second 1,000 events were the first validation intramural cohort, and the remaining 361 cases belonged to a second validation extramural cohort.
  
  
  RESULTS
  (1) A modified POSSUM equation was obtained. (2) Logistic regression was used to yield a statistically significant equation that included age, hemoglobin, white cell count, sodium and operative severity. (3) A chi-square automatic interaction detector decision tree analysis yielded a statistically significant equation with 4 variables, namely cardiac failure, sodium, operative severity, and peritoneal soiling.
  
  
  CONCLUSIONS
  A modified POSSUM equation and a simplified scoring system (aLicante sUrgical Community Emergencies New Tool for the enUmeration of Morbidities [LUCENTUM]) are described. Both tools significantly improve prediction of surgical morbidity in community-acquired gastrointestinal surgical emergencies.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante (HGUA), Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Celia Villodre, calle Pintor Baeza, 12, 03010 Alicante, Spain. Electronic address: celivii@gmail.com.
authors.forename: Celia
authors.initials: C
authors.lastname: Villodre
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Parc Taulí, Sabadell, Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Rebasa
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante (HGUA), Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Celia Villodre, calle Pintor Baeza, 12, 03010 Alicante, Spain.
authors.forename: José Luís
authors.initials: JL
authors.lastname: Estrada
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante (HGUA), Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Celia Villodre, calle Pintor Baeza, 12, 03010 Alicante, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Zaragoza
authors.affiliation: Servicio de Farmacología, HGUA, FISABIO, Alicante, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Zapater
authors.affiliation: Unidad de Documentación Clínica y Admisión, HGUA, FISABIO, Alicante, Spain.
authors.forename: Luís
authors.initials: L
authors.lastname: Mena
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante (HGUA), Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Celia Villodre, calle Pintor Baeza, 12, 03010 Alicante, Spain.
authors.forename: Félix
authors.initials: F
authors.lastname: Lluís
mesh_terms: D000006:Abdomen, Acute / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D000368:Aged; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004630:Emergencies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008485:Medical Audit / Q000379:methods*; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013030:Spain; D016019:Survival Analysis
keywords: Gastrointestinal surgery; Morbidity risk; POSSUM system