P-POSSUM Score and Length of Stay

Correlation Between P-POSSUM Score and Length of Stay in Kidney Transplant Recipients

P-POSSUM score had a predictive power of >80% to predict the length of stay of kidney transplant recipients

Study Overview

• Status: Completed
• Conditions: Length of Stay
• Intervention / Treatment: Other: Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) score

• Study Type: Observational
• Enrollment (Actual): 225

Contacts and Locations

Study Locations

• Indonesia
  • DKI Jakarta
    • Jakarta Pusat, DKI Jakarta, Indonesia, 10430
      • Rumah Sakit Cipto Mangunkusumo

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Medical record of recipients who undewernt kidney transplant during a period between January 2015 and December 2017

Description

Inclusion Criteria:

• Subjects are medical record of recipients who underwent kidney transplant

Exclusion Criteria:

• Medical record was incomplete
• Patients who died during surgery or before the patient was discharged.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Retrospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Not prolonged length of stay; Living donor patients who had ≤ 6 days length of stay after laparoscopic nephrectomy procedure	Other: Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) score; P-POSSUM score's variables are divided into physiological parameters (age, cardiac, respiratory, ECG, systolic blood pressure, pulse rate, haemoglobin, leukocyte count, urea, sodium plasma, potassium plasma, and GCS) and operative parameters (operation type, number of procedures, operative blood loss, peritoneal contamination, malignancy status, CEPOD).
Prolonged length of stay; Living donor patients who had > 6 days length of stay after laparoscopic nephrectomy procedure	Other: Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) score; P-POSSUM score's variables are divided into physiological parameters (age, cardiac, respiratory, ECG, systolic blood pressure, pulse rate, haemoglobin, leukocyte count, urea, sodium plasma, potassium plasma, and GCS) and operative parameters (operation type, number of procedures, operative blood loss, peritoneal contamination, malignancy status, CEPOD).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Correlation between each variable of P-POSSUM and length of stay	Correlation between 18 variables (12 variables as physical parameters and 6 variables as operative parameters) and length of stay	1 day before surgery until discharged from hospital, up to 30 days
P-POSSUM score Discrimination	P-POSSUM score ability to discriminate length of stay based on variable scores: physical parameters and operative parameters	1 day before surgery until discharged from hospital, up to 30 days
P-POSSUM score Calibration	P-POSSUM score cutoff to predict length of stay based on variable scores: physical parameters and operative parameters	1 day before surgery until discharged from hospital, up to 30 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient's length of stay post kidney transplantation	Patient's length of stay post kidney transplantation	From post surgery until discharged from hospital, up to 30 days
P-POSSUM score (physical parameters): Age	The score for Age variable cut-off: point for <61 years; point for 61-71 years 4 point >71 years	1 day before surgery
P-POSSUM score (physical parameters): Heart disease	The score for heart disease variable cut-off: point for no heart failure; point for diuretic, digoxin or angina/hypertension medicine usage 4 point for peripheral edema, warfarin, or borderline cardiomegaly on chest X-ray (CXR)	1 day before surgery
P-POSSUM score (physical parameters): Lung disease	The score for lung disease variable cut-off: point for no dyspnea; points for exertional dyspnea or mild COPD on CXR 4 points for limiting dyspnea or moderate COPD on CXR 8 points for dyspnea at rest or fibrosis/consolidation on CXR	1 day before surgery
P-POSSUM score (physical parameters): ECG abnormality	The score for ECG abnormality variable cut-off: 1 point for normal ECG 4 points for atrial fibrillation (HR 60-90 8 points for 5 ectopic beats/min, Q waves or ST/T wave change	1 day before surgery
P-POSSUM score (physical parameters): Systolic blood pressure	The score for systolic blood pressure variable cut-off: point for 110 - 130 mmHg; points for 100-109 mmHg or 131-170 mmHg 4 points for > 170 mmHg or 90-99 mmHg 8 points for < 90 mmHg	1 day before surgery
P-POSSUM score (physical parameters): Pulse rate	The score for pulse rate variable cut-off: point for 50-80 beats per minute (bpm); points for 40-59 bpm or 81-100 bpm 4 points for 101-120 bpm 8 points for > 121 bpm or < 40 bpm	1 day before surgery
P-POSSUM score (physical parameters): Hemoglobin	The score for hemoglobin variable cut-off: point for 13-16 g/dL; points for 11.5-12.9 or 16.1-17 d/dL 4 points for 10-11.4 or 17.1-18 g/dL 8 points for <10 or >18 g/dL	1 day before surgery
P-POSSUM score (physical parameters): Leukocyte count	The score for leukocyte count variable cut-off: point for 4.000-10.000/mm3; points for 10.100-20.000 atau 3.100-4.000/mm3 4 points for >20.000 atau <3.000/mm3	1 day before surgery
P-POSSUM score (physical parameters): Plasma potassium concentration	The score for plasma potassium concentration variable cut-off: point for 3.5-5 mmol/L; points for 3.2-3.4 or 5.1-5.3 mmol/L 4 points for 2.9-3.1 or 5.4-5.9 mmol/L 8 points for <2.9 or >5.9 mmol/L	1 day before surgery
P-POSSUM score (physical parameters): Plasma sodium concentration	The score for plasma sodium concentration variable cut-off: point for >135 mmol/L; points for 131-135 mmol/L 4 points for 126-130 mmol/L 8 points for <126 mmol/L	1 day before surgery
P-POSSUM score (operative parameters): Number of procedures	The score for number of procedures variable cut-off: 1 point for one 4 points for two 8 points for more than two	1 day before surgery
P-POSSUM score (operative parameters): Intraoperative blood loss	The score for intraoperative blood loss variable cut-off: point for <100 mL; points for 101-500 mL 4 points for 501-999 mL 8 points for > 999 mL	Intraoperative
P-POSSUM score (operative parameters): Peritoneal contamination/soiling	The score for peritoneal contamination/soiling variable cut-off: point for none; points for minor (serous fluid) 4 points for local pus 8 points for free bowel content, pus or blood	Intraoperative
P-POSSUM score (operative parameters): Presence of malignancy	The score for presence of malignancy variable cut-off: point for none; points for primary only 4 points for nodal metastases 8 points for distant metastases	1 day before surgery
P-POSSUM score (operative parameters): Mode of surgery	The score for mode of surgery variable cut-off: 1 point for elective 4 points for emergency resuscitation of > 2 hours possible operation < 24 hours after admission 8 points for emergency (immediate surgery < 2 hours needed)	1 day before surgery

Collaborators and Investigators

• Sponsor: Indonesia University
• Investigators: Study Chair: Dita Aditianingsih, M.D, PhD, Department of Anesteshiology and Intensive Care, Cipto Mangunkusumo Hospital, Universitas Indonesia

Publications and helpful links

General Publications

• Reyna-Sepulveda F, Ponce-Escobedo A, Guevara-Charles A, Escobedo-Villarreal M, Perez-Rodriguez E, Munoz-Maldonado G, Hernandez-Guedea M. Outcomes and Surgical Complications in Kidney Transplantation. Int J Organ Transplant Med. 2017;8(2):78-84. Epub 2017 May 1.
• Howes TE, Cook TM, Corrigan LJ, Dalton SJ, Richards SK, Peden CJ. Postoperative morbidity survey, mortality and length of stay following emergency laparotomy. Anaesthesia. 2015 Sep;70(9):1020-7. doi: 10.1111/anae.12991. Epub 2015 Apr 15.
• McAdams-DeMarco MA, King EA, Luo X, Haugen C, DiBrito S, Shaffer A, Kucirka LM, Desai NM, Dagher NN, Lonze BE, Montgomery RA, Walston J, Segev DL. Frailty, Length of Stay, and Mortality in Kidney Transplant Recipients: A National Registry and Prospective Cohort Study. Ann Surg. 2017 Dec;266(6):1084-1090. doi: 10.1097/SLA.0000000000002025.
• Khambalia HA, Moinuddin Z, Summers AM, Tavakoli A, Pararajasingam R, Campbell T, Dhanda R, Forgacs B, Augustine T, van Dellen D. A prospective cohort study of risk prediction in simultaneous pancreas and kidney transplantation. Ann R Coll Surg Engl. 2015 Sep;97(6):445-50. doi: 10.1308/rcsann.2015.0001. Epub 2015 Aug 14.
• Grocott MP, Levett DZ, Matejowsky C, Emberton M, Mythen MG. ASA scores in the preoperative patient: feedback to clinicians can improve data quality. J Eval Clin Pract. 2007 Apr;13(2):318-9. doi: 10.1111/j.1365-2753.2006.00736.x. No abstract available.
• Chen T, Wang H, Wang H, Song Y, Li X, Wang J. POSSUM and P-POSSUM as predictors of postoperative morbidity and mortality in patients undergoing hepato-biliary-pancreatic surgery: a meta-analysis. Ann Surg Oncol. 2013 Aug;20(8):2501-10. doi: 10.1245/s10434-013-2893-x. Epub 2013 Feb 23.
• Moonesinghe SR, Mythen MG, Das P, Rowan KM, Grocott MP. Risk stratification tools for predicting morbidity and mortality in adult patients undergoing major surgery: qualitative systematic review. Anesthesiology. 2013 Oct;119(4):959-81. doi: 10.1097/ALN.0b013e3182a4e94d.
• Baron DM, Hochrieser H, Posch M, Metnitz B, Rhodes A, Moreno RP, Pearse RM, Metnitz P; European Surgical Outcomes Study (EuSOS) group for Trials Groups of European Society of Intensive Care Medicine; European Society of Anaesthesiology. Preoperative anaemia is associated with poor clinical outcome in non-cardiac surgery patients. Br J Anaesth. 2014 Sep;113(3):416-23. doi: 10.1093/bja/aeu098. Epub 2014 May 14.
• Li S, Zhou K, Lai Y, Shen C, Wu Y, Che G. Estimated intraoperative blood loss correlates with postoperative cardiopulmonary complications and length of stay in patients undergoing video-assisted thoracoscopic lung cancer lobectomy: a retrospective cohort study. BMC Surg. 2018 May 23;18(1):29. doi: 10.1186/s12893-018-0360-0.
• Amer MS, Hamza SA, Wahba HMF, Barakat DB. Effects of Anemia on The Outcome in Elderly Admitted to The ICU. Indian J Med Res Pharm Sci. 2016;3(April):27-32.

Study record dates

Study Major Dates

• Study Start (Actual): May 15, 2018
• Primary Completion (Actual): August 15, 2018
• Study Completion (Actual): October 18, 2018

Study Registration Dates

• First Submitted: April 24, 2019
• First Submitted That Met QC Criteria: April 27, 2019
• First Posted (Actual): May 1, 2019

Study Record Updates

• Last Update Posted (Actual): May 1, 2019
• Last Update Submitted That Met QC Criteria: April 27, 2019
• Last Verified: April 1, 2019

More Information

Terms related to this study

• Keywords: transplant; mortality; kidney; length of stay; morbidity
• Other Study ID Numbers: IndonesiaUAnes034

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No