Correspondence |

We Need New Scoring Systems for Predicting Surgical Outcomes

Mesut Tez, MD; Selda Tez, MD; Necdet Özalp, MD
Arch Surg. 2008;143(4):425-426. doi:10.1001/archsurg.143.4.425-b.
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In a recent article in Archives, Horzic and colleagues1 suggest that the specialized colorectal Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (Cr-POSSUM) is a promising tool for monitoring surgical outcomes in colorectal cancer surgery and there is a need for new scoring systems outside original development and validation populations. We agree with the authors.

In a previous study, we evaluated the predictive accuracy of Portsmouth POSSUM (P-POSSUM) and Cr-POSSUM models on 321 patients undergoing colorectal resections, and we concluded that Cr-POSSUM may provide a better estimate of the risk of mortality.2 Predicting surgical outcome is an important component of the decision-making process, and the scoring systems (eg, American Society of Anesthesiologists score, Acute Physiology and Chronic Health Evaluation II and III, and POSSUM) have long been accepted for establishing patient outcomes in surgery. Although these models perform well in predicting the mortality or morbidity in the original cohorts in which they were developed, they may underestimate or overestimate mortality or morbidity in different populations.3

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