European Surgery

, Volume 49, Issue 2, pp 89–94 | Cite as

Prediction of 30-day mortality after emergency surgery for colorectal perforation

Validation of the Portsmouth and colorectal physiologic and operative severity scoring systems for the enumeration of mortality and morbidity (P-POSSUM and Cr-POSSUM)
  • Tomoyuki Abe
  • Ken ShirabeEmail author
  • Norifumi Harimoto
  • Tomonobu Gion
  • Takashi Nagaie
  • Kiyoshi Kajiyama
original article



We aimed to validate the use of two physiologic and operative severity scoring systems for the enumeration of mortality and morbidity (Portsmouth, P‑POSSUM; colorectal, Cr-POSSUM) for the prediction of 30-day mortality after emergency surgery for colorectal perforation.


We retrospectively reviewed the records of a consecutive series of patients who had undergone emergency surgery for colorectal perforation between April 2001 and July 2007 at our hospital. The study population was stratified into two groups according to whether the patients survived longer than 30 days postoperatively or died within 30 days of surgery. Two scoring systems (P-POSSUM and Cr-POSSUM) were used to predict mortality risk in each patient based on patient- and disease-related risk factors. The prediction capability for each scoring system was calculated based on the area under the receiver-operator characteristic curve.


The 30-day mortality rate was 12% (8/66 patients). Significant differences between patients who died within 30 days postoperatively and those who survived were noted regarding age, but not regarding comorbidities or preoperative laboratory data. Patient-related factors, rather than surgical factors, had a significantly greater influence on postoperative outcomes (p = 0.025), but the operative severity score did not contribute significantly. The P‑POSSUM score was a significant predictor of 30-day mortality (p = 0.0075).


Our findings demonstrate that P‑POSSUM and Cr-POSSUM can both be used to predict mortality after emergency surgery for colorectal perforation. While not explicitly developed for colorectal surgery, P‑POSSUM represents a promising tool for monitoring outcomes after emergency surgery for colorectal perforation.


Colorectal perforation Emergency surgery POSSUM P-POSSUM Cr-POSSUM 


Conflict of interest

T. Abe, K. Shirabe, N. Harimoto, T. Gion, T. Nagaie, and K. Kajiyama declare that they have no competing interests.


  1. 1.
    Skala K, Gervaz P, Buchs N, Inan I, Secic M, Mugnier-Konrad B, Morel P. Risk factors for mortality-morbidity after emergency-urgent colorectal surgery. Int J Colorectal Dis. 2009;24(3):311–6.CrossRefGoogle Scholar
  2. 2.
    Oomen JL, Engel AF, Cuesta MA. Mortality after acute surgery for complications of diverticular disease of the sigmoid colon is almost exclusively due to patient related factors. Colorectal Dis. 2006;8(2):112–9.CrossRefGoogle Scholar
  3. 3.
    Guy RJ, Moin T. Mortality after acute surgery for complications of diverticular disease of the sigmoid colon is almost exclusively due to patient-related factors. Colorectal Dis. 2006;8(5):453.CrossRefGoogle Scholar
  4. 4.
    Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg. 1991;78(3):355–60.CrossRefGoogle Scholar
  5. 5.
    Tekkis PP, Prytherch DR, Kocher HM, Senapati A, Poloniecki JD, Stamatakis JD, Windsor AC. Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM). Br J Surg. 2004;91(9):1174–82.CrossRefGoogle Scholar
  6. 6.
    Whiteley MS, Prytherch DR, Higgins B, Weaver PC, Prout WG. An evaluation of the POSSUM surgical scoring system. Br J Surg. 1996;83(6):812–5.CrossRefGoogle Scholar
  7. 7.
    Senagore AJ, Warmuth AJ, Delaney CP, Tekkis PP, Fazio VW. POSSUM, p‑POSSUM, and Cr-POSSUM: implementation issues in a United States health care system for prediction of outcome for colon cancer resection. Dis Colon Rectum. 2004;47(9):1435–41.CrossRefGoogle Scholar
  8. 8.
    Prytherch DR, Whiteley MS, Higgins B, Weaver PC, Prout WG, Powell SJ. POSSUM and Portsmouth POSSUM for predicting mortality. Br J Surg. 1998;85(9):1217–20.CrossRefGoogle Scholar
  9. 9.
    Tran Ba Loc P, Tezenas du Montcel S, Duron JJ, Levard H, Suc B, Descottes B, Desrousseaux B, Hay JM. Elderly POSSUM, a dedicated score for prediction of mortality and morbidity after major colorectal surgery in older patients. Br J Surg. 2010;97(3):396–403.CrossRefGoogle Scholar
  10. 10.
    Leung E, Ferjani AM, Stellard N, Wong LS. Predicting post-operative mortality in patients undergoing colorectal surgery using P‑POSSUM and CR-POSSUM scores: a prospective study. Int J Colorectal Dis. 2009;24(12):1459–64.CrossRefGoogle Scholar
  11. 11.
    Zorcolo L, Covotta L, Carlomagno N, Bartolo DC. Toward lowering morbidity, mortality, and stoma formation in emergency colorectal surgery: the role of specialization. Dis Colon Rectum. 2003;46(11):1461–7.CrossRefGoogle Scholar
  12. 12.
    Buchs NC, Gervaz P, Bucher P, Huber O, Mentha G, Morel P. Lessons learned from one thousand consecutive colonic resections in a teaching hospital. Swiss Med Wkly. 2007;137(17/18):259–64.PubMedGoogle Scholar
  13. 13.
    Horzic M, Kopljar M, Cupurdija K, Bielen DV, Vergles D, Lackovic Z. Comparison of P‑POSSUM and Cr-POSSUM scores in patients undergoing colorectal cancer resection. Arch Surg. 2007;142(11):1043–8.CrossRefGoogle Scholar
  14. 14.
    Oomen JL, Cuesta MA, Engel AF. Comparison of outcome of POSSUM, p‑POSSUM, and cr-POSSUM scoring after elective resection of the sigmoid colon for carcinoma or complicated diverticular disease. Scand J Gastroenterol. 2007;42(7):841–7.CrossRefGoogle Scholar
  15. 15.
    Vather R, Zargar-Shoshtari K, Adegbola S, Hill AG. Comparison of the POSSUM, P‑POSSUM and Cr-POSSUM scoring systems as predictors of postoperative mortality in patients undergoing major colorectal surgery. ANZ J Surg. 2006;76(9):812–6.CrossRefGoogle Scholar
  16. 16.
    Gocmen E, Koc M, Tez M, Keskek M, Kilic M, Ertan T. Evaluation of P‑POSSUM and O‑POSSUM scores in patients with gastric cancer undergoing resection. Hepatogastroenterology. 2004;51(60):1864–6.PubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  • Tomoyuki Abe
    • 1
  • Ken Shirabe
    • 2
    Email author
  • Norifumi Harimoto
    • 3
  • Tomonobu Gion
    • 1
  • Takashi Nagaie
    • 1
  • Kiyoshi Kajiyama
    • 1
  1. 1.Department of SurgeryIizuka hospitalIizukaJapan
  2. 2.Department of Hepato-biliary and Pancreatic SurgeryGunma UniversityMaebashiJapan
  3. 3.Department of Surgery and Sciences, Graduate School of Medical SciencesKyushu UniversityHigashi-KuJapan

Personalised recommendations