Application of Portsmouth modification of physiological and operative severity scoring system for enumeration of morbidity and mortality (P-POSSUM) in pancreatic surgery

Abstract

P-POSSUM underestimated the mortality rate. While P-POSSUM analysis gave a truer prediction of morbidity, underestimation of morbidity and potential for systematic inaccuracy in prediction of complications at lower risk levels is a significant issue for pancreatic surgery.

Evaluation of Surgical Outcome Scores according to ISGPS Definitions in Patients Undergoing Pancreatic Resection

“…In our study, POSSUM failed to accurately predict mortality, overestimating by a factor of 4. p-POSSUM performed better but still overpredicted mortality by a factor of 1.25. A morbidity rate of 55.5% (n = 55) shows that morbidity remains high after major pancreatic resection, although this is in keeping with other reports [2,5,6,7,8]. This includes a high number of ISGPS grade A POPF, which represents the biochemical detection of any measurable volume of drain fluid on or after post-operative day 3, with an amylase content >3 times the upper normal serum value and has no clinical effect [22].…”

“…Our in-hospital or 30-day mortality rate of 3% is comparable with the accepted mortality rate of <5% published by other specialist centres [5,6,7,8,10,11,12]. In our study, POSSUM failed to accurately predict mortality, overestimating by a factor of 4. p-POSSUM performed better but still overpredicted mortality by a factor of 1.25.…”

“…4). When analysing p-POSSUM, Tamijmarane et al [8] also found a similar spread of data with regards to the mean operative score but with a much lower mean of 13.7. This was in part due to the authors separating the surgical procedures into either ‘major’ or ‘major+’ depending on whether a venous resection or a resection of the neighbouring viscera was performed.…”

“…In 1995, an epidemiological study of over 13,500 patients in the UK reported a 30-day mortality of around 30% [1]. Over the past decade, advances in the standards of surgery for pancreatic cancer have been made with specialist centres reporting much improved mortality rates of between 1 and 5%, although morbidity remains high [2,3,4,5,6,7,8,9,10,11,12]. Crude rates of morbidity and mortality may be misleading as comparing rates without details of case mix provides little insight into the complex nature of these patients and the intensive level of peri-operative management they require.…”

Sociodemographics and Comorbidities Influence Decisions to Undergo Pancreatic Resection for Neoplastic Lesions

“…14 Several scoring systems have been developed which predict perioperative morbidity and mortality during major surgery. [15][16][17] The Charlson comorbidity index (CCI), 18 initially developed to predict mortality in longitudinal studies and later validated in combination with age-the combined comorbidity index (ACCI)-to predict perioperative complications, 19 has been used to aid operative decision making for both renal 20 and bladder 21 tumors. The ACCI gives a weighted score to comorbidities and age (Table 1) to provide the combined comorbidity index for an individual patient and was designed to evaluate long-term survival in patients undergoing general surgical procedures.…”