Risk Assessment of Mortality Following Intraoperative Cardiac Arrest Using POSSUM and P-POSSUM in Adults Undergoing Non-Cardiac Surgery

• Published in: Yonsei medical journal Vol. 56; no. 5; pp. 1401 - 1407
• Main Authors: Kim, Shin Hyung, Kil, Hae Keum, Kim, Hye Jin, Koo, Bon Nyeo
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.09.2015; 연세대학교의과대학
• Subjects: Adult; Aged; Female; Heart Arrest - complications; Heart Arrest - mortality; Humans; Incidence; Intraoperative Complications - mortality; Male; Middle Aged; Morbidity; Original; Postoperative Period; Republic of Korea - epidemiology; Retrospective Studies; Risk Assessment - methods; ROC Curve; Severity of Illness Index; Surgical Procedures, Operative - mortality; 의학일반; Republic of Korea; mortality; Cardiac arrest; surgery
• ISSN: 0513-5796; 1976-2437
• DOI: 10.3349/ymj.2015.56.5.1401

The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) and its Portsmouth modification (P-POSSUM) are comprehensive assessment methods for evaluating patient and surgical factors widely used to predict 30-day mortality rates. In this retrospective study, we evaluated the usefulness of POSSUM and P-POSSUM in predicting 30-day mortality after intraoperative cardiac arrests in adult patients undergoing non-cardiac surgery. Among 190486 patients who underwent anesthesia, 51 experienced intraoperative cardiac arrest as defined in our study protocol. Predicted mortality rates were calculated using POSSUM and P-POSSUM equations and were compared with actual outcomes using exponential and linear analyses. In addition, a receiver operating characteristic curve analysis was undertaken, and area-under-the-curve (AUC) values with confidence intervals (CIs) were calculated for POSSUM and P-POSSUM. Among the 51 patients with intraoperative cardiac arrest, 32 (62.7%) died within 30 days postoperatively. The overall predicted 30-day mortality rates using POSSUM and P-POSSUM were 65.5% and 57.5%, respectively. The observed-to-predicted (O:E) ratio for the POSSUM 30-day mortality was 1.07, with no significant difference between the observed and predicted values (χ²=4.794; p=0.779). P-POSSUM predicted mortality equally well, with an O:E ratio of 1.10 (χ²=8.905; p=0.350). AUC values (95% CI) were 0.771 (0.634-0.908) and 0.785 (0.651-0.918) for POSSUM and P-POSSUM, respectively. Both POSSUM and P-POSSUM performed well to predict overall 30-day mortality following intraoperative cardiac arrest in adults undergoing non-cardiac surgery at a university teaching hospital in Korea.