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P-POSSUM as mortality predictor in COVID-19-infected patients submitted to emergency digestive surgery. A
Zoilo Madrazo1, Javier Osorio, Sebastián Videla
1Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain Clinical Research Support Unit (HUB-IDIBELL), Clinical Pharmacology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain Department of Surgery, Donostia University Hospital, San Sebastian, Spain Department of Surgery, Parc Taulí Health Corporation, Sabadell Hospital, Sabadell, Spain Department of Surgery, Arnau de Vilanova University Hospital, Lleida, Spain Department of Surgery, Hospital del Mar University Hospital, Barcelona, Spain Department of Surgery. Basurto University Hospital, Bilbao, Spain Department of Surgery, Granollers General Hospital, Granollers, Spain Department of Surgery, Cruces University Hospital, Bilbao, Spain Department of Surgery, Althaia Foundation, Manresa, Spain Department of Surgery, Terrassa Health Consortium, Terrassa Hospital, Terrassa, Spain General Surgery Department, Vall d'Hebrón University Hospital, Barcelona, Spain Hepatobiliopancreatic Surgery and Transplantation Department, Vall d'Hebrón University Hospital, Barcelona, Spain Department of Surgery, Viladecans Hospital, Viladecans, Spain Department of Surgery, Mataró Hospital, Maresme Health Consortium, Mataró, Spain Department of Surgery, Germans Trias i Pujol University Hospital, Badalona, Spain Department of Surgery, Sant Joan de Deu Hospital Foundation, Martorell, Spain Department of Surgery, Dr. José Molina Orosa Hospital, Lanzarote, Spain Department of Surgery, Joan XXIII University Hospital, Tarragona, Spain Department of Surgery, Igualada University Hospital, Anoia Health Consortium, Igualada, Spain Department of Surgery, Sant Pau University Hospital, Barcelona, Spain Department of Surgery. Moisès Broggi Hospital, Sant Joan Despí, Spain Department of Surgery, Mútua de Terrassa University Hospital, Terrassa, Spain Department of Surgery, Girona Dr.Josep Trueta University Hospital, Girona, Spain Department of Surgery, Alto Deba Hospital, Mondragon, San Sebastián, Spain Department of Surgery, Araba University Hospital, Txagorritxu Hospital, Vitoria, Spain Clinical Research Support Unit, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
Background:
COVID-19 infection is associated with a higher mortality rate in surgical patients, but surgical risk scores have not been validated in the emergency setting. We aimed to study the capacity for postoperative mortality prediction of the P-POSSUM score in COVID-19-positive patients submitted to emergency general and digestive surgery.
Material And Methods:
Consecutive patients undergoing emergency general and digestive surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective cohort study.
Main Outcome:
30-day mortality. P-POSSUM discrimination was quantified by the area under the curve (AUC) of ROC curves; calibration was assessed by linear regression slope (β estimator); and sensitivity and specificity were expressed as percentage and 95% confidence interval (CI).
Results:
4988 patients were included: 177 COVID-19-positive; 2011 intra-pandemic COVID-19-negative; and 2800 pre-pandemic. COVID-19-positive patients were older, with higher surgical risk, more advanced pathologies, and higher P-POSSUM values (1.79% vs. 1.09%, p < 0.001, in both the COVID-19-negative and control cohort). 30-day mortality in the COVID-19-positive, intra-pandemic COVID-19-negative and pre-pandemic cohorts were: 12.9%, 4.6%, and 3.2%. The P-POSSUM predictive values in the three cohorts were, respectively: AUC 0.88 (95% CI 0.81-0.95), 0.89 (95% CI 0.87-0.92), and 0.91 (95% CI 0.88-0.93); β value 0.97 (95% CI 0.74-1.2), 0.99 (95% CI 0.82-1.16), and 0.78 (95% CI 0.74-0.82); sensitivity 83% (95% CI 61-95), 91% (95% CI 84-96), and 89% (95% CI 80-94); and specificity 81% (95% CI 74-87), 76% (95% CI 74-78), and 80% (95% CI 79-82).
Conclusion:
The P-POSSUM score showed a good predictive capacity for postoperative mortality in COVID-19-positive patients submitted to emergency general and digestive surgery.
