The level of postoperative care influences mortality prediction by the POSPOM score: A retrospective cohort analysis.

<h4>Background</h4>The Preoperative Score to Predict Postoperative Mortality (POSPOM) assesses the patients' individual risk for postsurgical intrahospital death based on preoperative parameters. We hypothesized that mortality predicted by the POSPOM varies depending on the level of...

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Autores principales:	Jan Menzenbach, Yannik C Layer, Yonah L Layer, Andreas Mayr, Mark Coburn, Maria Wittmann, Tobias Hilbert
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/2ff1c2b820834fb9a44f8bf72c470409
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spelling	oai:doaj.org-article:2ff1c2b820834fb9a44f8bf72c4704092021-12-02T20:14:01ZThe level of postoperative care influences mortality prediction by the POSPOM score: A retrospective cohort analysis.1932-620310.1371/journal.pone.0257829https://doaj.org/article/2ff1c2b820834fb9a44f8bf72c4704092021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0257829https://doaj.org/toc/1932-6203<h4>Background</h4>The Preoperative Score to Predict Postoperative Mortality (POSPOM) assesses the patients' individual risk for postsurgical intrahospital death based on preoperative parameters. We hypothesized that mortality predicted by the POSPOM varies depending on the level of postoperative care.<h4>Methods</h4>All patients age over 18 years undergoing inpatient surgery or interventions involving anesthesia at a German university hospital between January 2006, and December 2017, were assessed for eligibility for this retrospective study. Endpoint was death in hospital following surgery. Adaptation of the POSPOM to the German coding system was performed as previously described. The whole cohort was divided according to the level of postoperative care (normal ward vs. intensive care unit (ICU) admission within 24 h vs. later than 24 h, respectively).<h4>Results</h4>199,258 patients were finally included. Observed intrahospital mortality was 2.0% (4,053 deaths). 9.6% of patients were transferred to ICU following surgery, and mortality of those patients was increased already at low POSPOM values of 15. 17,165 patients were admitted to ICU within 24 h, and these patients were older, had more comorbidities, or underwent more invasive surgery, reflected by a higher median POSPOM score compared to the normal-ward group (29 vs. 17, p <0.001). Mortality in that cohort was significantly increased to 8.7% (p <0.001). 2,043 patients were admitted to ICU later than 24 h following surgery (therefore denoted unscheduled admission), and the median POSPOM value of that group was 23. Observed mortality in this cohort was highest (13.5%, p <0.001 vs. ICU admission <24 h cohort).<h4>Conclusion</h4>Increased mortality in patients transferred to high-care wards reflects the significance of, e.g., intra- or early postoperative events for the patients' outcome. Therefore, scoring systems considering only preoperative variables such as the POSPOM reveal limitations to predict the individual benefit of postoperative ICU admission.Jan MenzenbachYannik C LayerYonah L LayerAndreas MayrMark CoburnMaria WittmannTobias HilbertPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 9, p e0257829 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jan Menzenbach Yannik C Layer Yonah L Layer Andreas Mayr Mark Coburn Maria Wittmann Tobias Hilbert The level of postoperative care influences mortality prediction by the POSPOM score: A retrospective cohort analysis.
description	<h4>Background</h4>The Preoperative Score to Predict Postoperative Mortality (POSPOM) assesses the patients' individual risk for postsurgical intrahospital death based on preoperative parameters. We hypothesized that mortality predicted by the POSPOM varies depending on the level of postoperative care.<h4>Methods</h4>All patients age over 18 years undergoing inpatient surgery or interventions involving anesthesia at a German university hospital between January 2006, and December 2017, were assessed for eligibility for this retrospective study. Endpoint was death in hospital following surgery. Adaptation of the POSPOM to the German coding system was performed as previously described. The whole cohort was divided according to the level of postoperative care (normal ward vs. intensive care unit (ICU) admission within 24 h vs. later than 24 h, respectively).<h4>Results</h4>199,258 patients were finally included. Observed intrahospital mortality was 2.0% (4,053 deaths). 9.6% of patients were transferred to ICU following surgery, and mortality of those patients was increased already at low POSPOM values of 15. 17,165 patients were admitted to ICU within 24 h, and these patients were older, had more comorbidities, or underwent more invasive surgery, reflected by a higher median POSPOM score compared to the normal-ward group (29 vs. 17, p <0.001). Mortality in that cohort was significantly increased to 8.7% (p <0.001). 2,043 patients were admitted to ICU later than 24 h following surgery (therefore denoted unscheduled admission), and the median POSPOM value of that group was 23. Observed mortality in this cohort was highest (13.5%, p <0.001 vs. ICU admission <24 h cohort).<h4>Conclusion</h4>Increased mortality in patients transferred to high-care wards reflects the significance of, e.g., intra- or early postoperative events for the patients' outcome. Therefore, scoring systems considering only preoperative variables such as the POSPOM reveal limitations to predict the individual benefit of postoperative ICU admission.
format	article
author	Jan Menzenbach Yannik C Layer Yonah L Layer Andreas Mayr Mark Coburn Maria Wittmann Tobias Hilbert
author_facet	Jan Menzenbach Yannik C Layer Yonah L Layer Andreas Mayr Mark Coburn Maria Wittmann Tobias Hilbert
author_sort	Jan Menzenbach
title	The level of postoperative care influences mortality prediction by the POSPOM score: A retrospective cohort analysis.
title_short	The level of postoperative care influences mortality prediction by the POSPOM score: A retrospective cohort analysis.
title_full	The level of postoperative care influences mortality prediction by the POSPOM score: A retrospective cohort analysis.
title_fullStr	The level of postoperative care influences mortality prediction by the POSPOM score: A retrospective cohort analysis.
title_full_unstemmed	The level of postoperative care influences mortality prediction by the POSPOM score: A retrospective cohort analysis.
title_sort	level of postoperative care influences mortality prediction by the pospom score: a retrospective cohort analysis.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/2ff1c2b820834fb9a44f8bf72c470409
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The level of postoperative care influences mortality prediction by the POSPOM score: A retrospective cohort analysis.

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