PAST LETTERS FROM THE PRESIDENT
K Narayanasetty*, M Mueller**, J Fonseca**, RS Ahluwalia***
*Southampton University Hospitals, NHS Trust, **Maidstone and Tunbridge Wells NHS Trust, ***Colchester General Hospital, Essex Rivers NHS Trust
Introduction: We present the use of Orthopaedic POSSUM Score and Surgical Risk Score (SRS) in fracture neck of femur surgery. The objective of this study was to identify the physiological status at admission and at operation and differences in predictive and actual patient operative outcomes.
Material and Methods: All 338 consecutive, hip fractures from December to July 2005 at three hospitals were assessed prospectively. Collection of demographic, admission and operative POSSUM, and SRS scores, fracture pathology, physiological status, and outcomes were conducted.
Results: In total, 306 (90.5%) patients had surgery. The median age was 73 (range 55-95). The majority had co-morbidities (77.5%; n=237), as suggested by average ASA scores of 3.2. POSSUM predicted mortality was 13.6% (n=25) at 30 days, where as the SRS predicted 11.4% (n=21), but mortality was 7.1% (n=13) if operated before 48hours. Differences between admission and operative physiological Possum score increased with operative delay (table 1). Physiological scores over 30 had a 67.8% risk of 30-day mortality, 86 patients had an increase in physiological score from admission to operation, resulting in higher analgesic requirements and reduced mobility scores (P<0.005).
Conclusion: Possum and SRS over predict operative mortality, but comparison of admission and operative physiological POSSUM scores indicate room for improvement in preoperative care, if surgery is delayed.
Delay
in Surgery (Days) |
Number
of Patients |
Mean
POSSUM Physiological Score at operation |
Percentage
Change in Physiological POSSUM Score |
Percentage
of patients returning to original mobility status |
Mortality
at 30 days as patient numbers predicted and actual deaths (POSSUM/SRS/Actual) |
1 |
88 |
18
(12-27) |
-5.9%
|
77% |
9/7/4* |
2 |
86
|
23
(14-30) |
-10.6% |
68.9% |
16/14/7* |
3 |
69 |
25
(16-31) |
+3.7% |
53% |
-/32/15* |
4
|
38 |
28
(23-39) |
+5.6% |
42% |
-/25/13* |
| 5
or more |
25 |
31
(14-38) |
-6.8% |
40% |
-/23/12* |
|
Table
1:
Comparative results of predictive and actual mortality in using
the POSSUM, and Surgical Risk Scale. Results shown as dependent
on the timing of surgery in the study. The percentage change in
physiological POSSUM represents the difference from admission to
time of surgery and indicating clinical state. A positive change
in the physiological scores reflects a worsening of clinical status.
Orthopaedic POSSUM scores cannot be calculated for patients waiting
greater than 48hours. *Actual mortality figure is significantly
different from predicted with a P<0.006. |
|||||