Use this URL to cite or link to this record in EThOS:
Title: The development and validation of a scoring system to assess postoperative morbidity following cardiac surgery : the cardiac post-operative morbidity score (C-POMS)
Author: Sanders, J.
ISNI:       0000 0004 2731 8705
Awarding Body: University College London (University of London)
Current Institution: University College London (University of London)
Date of Award: 2011
Availability of Full Text:
Access from EThOS:
Access from Institution:
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.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available