Risk adjustment is crucial in comparing outcomes of various surgical modalities in patients with ileal perforation
<p>Abstract</p> <p>Background</p> <p>Using crude mortality and morbidity rates for comparing outcomes can be misleading. The aim of the present study was to compare the outcome of various surgical modalities without and with risk adjustment using Physiologic and Operati...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2008-11-01
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| Series: | Patient Safety in Surgery |
| Online Access: | http://www.pssjournal.com/content/2/1/31 |
| _version_ | 1818208594091311104 |
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| author | Arya Satyavrat Singh Tanveer Mohil Ravindra Bhatnagar Dinesh |
| author_facet | Arya Satyavrat Singh Tanveer Mohil Ravindra Bhatnagar Dinesh |
| author_sort | Arya Satyavrat |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Using crude mortality and morbidity rates for comparing outcomes can be misleading. The aim of the present study was to compare the outcome of various surgical modalities without and with risk adjustment using Physiologic and Operative Severity Scoring for the enUmeration of Mortality and morbidity (POSSUM) score in cases of ileal perforations.</p> <p>Methods</p> <p>Prospective study on 125 patients of ileal perforations. Resection anastamosis (Group I) was done in 38 patients, primary repair (Group II) in 42 patients and 45 patients had an ileostomy (Group III). The disease severity was assessed in all patients using POSSUM score. The odds of death without and with risk adjustment using POSSUM mortality score were calculated for all groups</p> <p>Results</p> <p>Seventeen patients (14%) patients died and 99 (79%) developed postoperative complications. Using crude mortality rates Group I appeared to be the best treatment option with only 2 (5%) deaths followed by Group II with 5 (12%) deaths where as Group III had the worst outcome with 10 deaths (22%). However, Group III (ileostomy) patients had higher mean POSSUM mortality and morbidity score (55.55%, 91.33%) than Group I (28%, 75.26%) and Group II (27%, 73.59%). Taking Group I as the reference (odds ratio, OR1) odds of death were greatest in Group III (OR 5.14, p = 0.043) followed by Group II (OR 2.43, p = 0.306). With risk adjustment using POSSUM mortality score the odds of death decreased in Group III (OR 1.16 p = 0.875). For the whole group, there was a significant association between the POSSUM score and postoperative complications and deaths. Mean POSSUM mortality and morbidity score of those who died (63.40 vs.33.68, p = 0.001) and developed complications (66.32 vs.84.20, p = 0.001) was significantly higher. For every percent increase in severity score the risk of postoperative complications and death increased by 1.10 (p = 0.001) and1.06 (p = 0.001) respectively.</p> <p>Conclusion</p> <p>Despite ileostomy patients having highest crude mortality and complication rates, after risk adjustment it was equally safe. Severity of the disease rather than the surgical option had a significant impact on the outcome in patients with ileal perforations.</p> |
| first_indexed | 2024-12-12T04:47:18Z |
| format | Article |
| id | doaj.art-0d6743732dae4296addc546b1d415264 |
| institution | Directory Open Access Journal |
| issn | 1754-9493 |
| language | English |
| last_indexed | 2024-12-12T04:47:18Z |
| publishDate | 2008-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Patient Safety in Surgery |
| spelling | doaj.art-0d6743732dae4296addc546b1d4152642022-12-22T00:37:34ZengBMCPatient Safety in Surgery1754-94932008-11-01213110.1186/1754-9493-2-31Risk adjustment is crucial in comparing outcomes of various surgical modalities in patients with ileal perforationArya SatyavratSingh TanveerMohil RavindraBhatnagar Dinesh<p>Abstract</p> <p>Background</p> <p>Using crude mortality and morbidity rates for comparing outcomes can be misleading. The aim of the present study was to compare the outcome of various surgical modalities without and with risk adjustment using Physiologic and Operative Severity Scoring for the enUmeration of Mortality and morbidity (POSSUM) score in cases of ileal perforations.</p> <p>Methods</p> <p>Prospective study on 125 patients of ileal perforations. Resection anastamosis (Group I) was done in 38 patients, primary repair (Group II) in 42 patients and 45 patients had an ileostomy (Group III). The disease severity was assessed in all patients using POSSUM score. The odds of death without and with risk adjustment using POSSUM mortality score were calculated for all groups</p> <p>Results</p> <p>Seventeen patients (14%) patients died and 99 (79%) developed postoperative complications. Using crude mortality rates Group I appeared to be the best treatment option with only 2 (5%) deaths followed by Group II with 5 (12%) deaths where as Group III had the worst outcome with 10 deaths (22%). However, Group III (ileostomy) patients had higher mean POSSUM mortality and morbidity score (55.55%, 91.33%) than Group I (28%, 75.26%) and Group II (27%, 73.59%). Taking Group I as the reference (odds ratio, OR1) odds of death were greatest in Group III (OR 5.14, p = 0.043) followed by Group II (OR 2.43, p = 0.306). With risk adjustment using POSSUM mortality score the odds of death decreased in Group III (OR 1.16 p = 0.875). For the whole group, there was a significant association between the POSSUM score and postoperative complications and deaths. Mean POSSUM mortality and morbidity score of those who died (63.40 vs.33.68, p = 0.001) and developed complications (66.32 vs.84.20, p = 0.001) was significantly higher. For every percent increase in severity score the risk of postoperative complications and death increased by 1.10 (p = 0.001) and1.06 (p = 0.001) respectively.</p> <p>Conclusion</p> <p>Despite ileostomy patients having highest crude mortality and complication rates, after risk adjustment it was equally safe. Severity of the disease rather than the surgical option had a significant impact on the outcome in patients with ileal perforations.</p>http://www.pssjournal.com/content/2/1/31 |
| spellingShingle | Arya Satyavrat Singh Tanveer Mohil Ravindra Bhatnagar Dinesh Risk adjustment is crucial in comparing outcomes of various surgical modalities in patients with ileal perforation Patient Safety in Surgery |
| title | Risk adjustment is crucial in comparing outcomes of various surgical modalities in patients with ileal perforation |
| title_full | Risk adjustment is crucial in comparing outcomes of various surgical modalities in patients with ileal perforation |
| title_fullStr | Risk adjustment is crucial in comparing outcomes of various surgical modalities in patients with ileal perforation |
| title_full_unstemmed | Risk adjustment is crucial in comparing outcomes of various surgical modalities in patients with ileal perforation |
| title_short | Risk adjustment is crucial in comparing outcomes of various surgical modalities in patients with ileal perforation |
| title_sort | risk adjustment is crucial in comparing outcomes of various surgical modalities in patients with ileal perforation |
| url | http://www.pssjournal.com/content/2/1/31 |
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