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Predicting postoperative morbidity by clinical assessment.

P M Markus1, J Martell, I Leister

  • 1Department of General Surgery, Georg-August Universität Goettingen, Robert Kochstrasse 40, 37075 Goettingen, Germany. pmarkus@med.uni-goettingen.de

The British Journal of Surgery
|January 7, 2005
PubMed
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Surgeon's intuition accurately predicts postoperative complications, outperforming the POSSUM scoring system in major gastrointestinal and hepatobiliary surgeries. This "gut-feeling" is particularly reliable for elective procedures.

Area of Science:

  • Surgical Outcomes Research
  • Clinical Prediction Models
  • Patient Safety

Background:

  • Assessing postoperative complications is crucial in major surgery.
  • Surgeon's subjective estimation of risk is a potential tool.
  • Objective scoring systems like POSSUM exist but may have limitations.

Purpose of the Study:

  • To evaluate the accuracy of surgeon's "gut-feeling" in predicting postoperative complications.
  • To compare the predictive accuracy of surgeon's intuition against the POSSUM and P-POSSUM scoring systems.
  • To analyze prediction accuracy in elective versus emergency major hepatobiliary and gastrointestinal surgery.

Main Methods:

  • Prospective study of 1077 patients undergoing major hepatobiliary/gastrointestinal surgery.

Related Experiment Videos

  • Surgeons predicted postoperative complication risk (0-100%) immediately post-op.
  • Surgeon predictions were compared to actual outcomes and POSSUM/P-POSSUM predictions.

    • Main Results:

    • Observed morbidity: 29.5%, mortality: 3.4%.
    • Surgeon's gut-feeling predicted morbidity at 32.1%, outperforming POSSUM (46.4%) and P-POSSUM (6.9% mortality).
    • Gut-feeling underestimated risk in emergency cases but overpredicted in elective cases; POSSUM systems overpredicted overall.

    Conclusions:

    • Surgeon's gut-feeling is a valuable predictor of postoperative outcomes, especially in elective surgery.
    • The POSSUM and P-POSSUM scoring systems tended to overpredict morbidity and mortality in this patient cohort.
    • Further research could explore integrating subjective and objective measures for enhanced risk prediction.