The association between surgical complications and the POSSUM score in head and neck reconstruction: a retrospective single-center study

Abstract

The Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) is widely used to predict surgical complications affecting various organs. However, there are few reports about objective evaluation methods for head and neck surgery. In this study, we retrospectively examined the association between POSSUM score and actual surgical complications of head and neck reconstruction surgery. In total, 711 patients who underwent head and neck reconstruction after cancer extirpation between January 2007 and January 2015 were studied. The predicted risk of complications was calculated using the POSSUM score and compared with the actual rate of perioperative complications. Perioperative complications occurred in 178 (25%) patients, comprising systemic complications in 52 (7%) patients, surgical site infection of the head and neck area in 78 (11%) patients and failure of the free flap in 55 (8.8%) patients. When patients were divided into a perioperative complication group and a no-complication group, a significant difference between the two groups was observed in the predicted postoperative rate calculated from the POSSUM score (p < .0001, odds ratio 1.03, 95% confidence interval = 1.02-1.04). Furthermore, the cutoff value of the POSSUM score calculated from the receiver operating characteristic curve using Youden's index was 43.0%. POSSUM is a useful risk indicator for head and neck reconstruction surgery. It is possible to objectively calculate the prediction level using a standard assessment method without adding burden to any medical facility. Therefore, patients may be considered at high risk for perioperative complications when the POSSUM score is 43.0% or higher.

Use of the Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (‘P-POSSUM’) to predict morbidity in patients undergoing surgery with reconstruction for temporal bone malignancy

“…Although extensively used and evaluated in general surgery, there are only a few reports of its application in head and neck surgery. 7 This study sought to determine whether the risk estimates for the Portsmouth scoring system could be used in major head and neck reconstructive surgery.…”

Evaluation and validation of Physiological and Operative Severity Score for the enumeration of mortality and morbidity and Portsmouth‐POSSUM scores in predicting morbidity and mortality in patients undergoing head and neck cancer surgeries

“…7 Even fewer studies have evaluated POSSUM for risk prediction in head and neck cancer surgery and the number of patients included in these studies is small. [7][8][9][10] We therefore decided to evaluate POSSUM and P-POS-SUM for predicting morbidity and mortality in patients with cancer undergoing head and neck surgeries.…”

“…There are few studies evaluating POSSUM and P‐POSSUM in predicting morbidity and mortality after head and neck surgery 7 . Even fewer studies have evaluated POSSUM for risk prediction in head and neck cancer surgery and the number of patients included in these studies is small 7‐10 …”