<p>Application of POSSUM and P-POSSUM in Surgical Risk Assessment of Elderly Patients Undergoing Hepatobiliary and Pancreatic Surgery</p>

Abstract

Purpose To investigate the efficacy and accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) scoring systems in the risk assessment of postoperative complications and death in elderly patients undergoing hepatobiliary and pancreatic surgery. Patients and Methods Using POSSUM and P-POSSUM, 274 elderly patients undergoing hepatobiliary and pancreatic surgery were evaluated, and the complications and deaths predicted by the systems were compared with the actual situation. The accuracy and predictive ability of POSSUM and P-POSSUM were evaluated using chi-squared and t -tests, consistency of predicted and actual complication rates (observed/expected, OE ratio), and receiver operating characteristic (ROC) curve. Results The complication rate predicted by POSSUM (R1) was 22.57%, while the actual postoperative complication rate was 17.88% (P>0.05). The mortality rate predicted by POSSUM (R2) was 4.61%, while the actual rate was 1.09% (P<0.05). The mortality rate predicted by P-POSSUM (R) was 1.42%, while the actual rate was 1.09% (P>0.05). Patients with complications had higher physiology scores (PS), operative severity scores (OS), and POSSUM scores than those without complications (P<0.05). Furthermore, PS, OS, and POSSUM scores were higher in the mortality group than in the survival group. However, the number of individuals in the mortality group was too small to accurately reflect the overall situation. Stratified analysis showed that consistency of the OE ratio in different subgroups was close to 1. The ROC curve showed that the area under the curve for the complication rate predicted by POSSUM was 0.76. Conclusion Although the postoperative mortality rate was higher than the actual value, POSSUM could accurately predict the postoperative complication rate in elderly patients undergoing hepatobiliary and pancreatic surgery. The P-POSSUM accurately predicted the postoperative mortality rate in this population. Patients with complications had higher POSSUM scores.

Perforated small bowel lymphoma presenting as an acute abdomen and requiring emergency surgery, a case report

“…The Portsmouth Physiological and Operative Severity score for the enumeration of Mortality and Morbidity(P-POSSUM) scoring system is a validated tool [17,18].There have been some concerns regarding its over-estimation of mortality in the literature [15] however it remains one of the most used tools. Pre-operative physiological parameters and intra-operative surgical parameters are used to predict the risk of complications and death in the post-operative period [19]. NELA is an alternative system used in emergency laparotomy [20].…”

Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study

“…These scores are then inserted into two formulas [ 23 ], and risks of both mortality and morbidity can be predicted for the workload of each surgical team. The POSSUM score has been validated for hepato-biliary-pancreatic surgery [ 24 , 25 ], gastric surgery [ 26 ], colorectal surgery [ 27 ] and emergency laparotomies [ 28 ]. The POSSUM score had already a validation in patients with ACC underwent EC or medical therapy [ 9 , 10 ], but, up to now, a formal prospective validation of POSSUM for EC in patients with ACC was lacking.…”

An observational study to assess effectiveness of POSSUM and P-POSSUM score for prediction of morbidity and mortality after surgery for ileal perforation

“…P-POSSUM score showed O/E ratio close to 1, which is better predictor of mortality rate. Ilahi I et al [19] and Zhi et al [22] also used the O:E ratio to compare the predicted and observed morbidity rates and found that the POSSUM score overestimated the mortality rate whereas P-POSSUM score was better in estimating mortality rate.…”