The development and validation of a scoring system to assess postoperative morbidity following cardiac surgery:
the cardiac post-operative morbidity score (C-POMS).
Doctoral thesis, UCL (University College London).
INTRODUCTION: Low post-operative death rates after cardiac surgery make mortality an inadequate outcome measure. As post-operative morbidity is more common, its measurement would be more sensitive. Accurate identification and quantification might also allow its aetiology to be addressed. The nine domain Post-Operative Morbidity Survey (POMS)(1) is the only prospective tool for standardised morbidity measurement in general surgical patients. I sought to develop and validate such a tool (cardiac- or C-POMS) for cardiac surgery. METHODS: Development: Morbidity was prospectively assessed in 450 cardiac surgery patients on postoperative days 1, 3, 5, 8 and 15 using POMS criteria and cardiac-specific variables (from an expert panel). Other morbidities were noted as free-text and included if prevalence >5%, missingness <5% and mean expert-rated severity-importance index score >8. Reliability/validity: assessed by expert panel review, using Cronbach’s alpha (internal consistency) and linear regression to test the ability of C-POMS to predict length of stay (LOS). Clinical utility: assessed by multi-professional teams at two hospitals. RESULTS: Development: Following item-reduction, C-POMS resulted in a 13 domain model. Reliability/validity: Internal consistency (>0.7) on D3-D15 permits use of C-POMS as a summative score of total morbidity burden. Mean C-POMS scores were 3.4 (D3), 2.6 (D5), 3.4 (D8) and 3.8 (D15). Patient LOS was 4.6 (p=0.012), 5.3 days (p=0.001) and 7.6 days (p=0.135) longer in patients with (compared to without) morbidity on D3, D5, D8 and D15, respectively. For every unit increase in C-POMS summary score subsequent LOS increased by 1.7 (D3), 2.2 (D5), 4.5 (D8) and 6.2 (D15) days (all p=0.000). Clinical utility: Demonstrated by C-POMS now being routinely collected at two hospitals. CONCLUSIONS: C-POMS is the first validated tool for identifying total morbidity burden post cardiac surgery. CPOMS identifies considerable morbidity in these patients and may assist in modelling causation and in identifying preventative and therapeutic targets.
|Title:||The development and validation of a scoring system to assess postoperative morbidity following cardiac surgery: the cardiac post-operative morbidity score (C-POMS)|
|Open access status:||An open access version is available from UCL Discovery|
|UCL classification:||UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Child Health|
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