Evaluation of POSSUM in Predicting Post-Operative Morbidity in Patients Undergoing Pancreaticoduodenectomy

Abstract

The Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) is a predictive scoring system for post-operative morbidity. The present study assessed the value of POSSUM in predicting post-operative morbidity following pancreaticoduodenectomy (PD). POSSUM scores were prospectively calculated for 265 consecutive cases of PD performed between 2005 and 2007. Expected morbidity was estimated based on POSSUM scores and was compared with observed morbidity. Patients were also stratified into one of four groups based on their individual POSSUM scores and subsequent risk of morbidity. Mean expected morbidity was 43.81% (116 cases) and mean observed morbidity was 39.62% (105 cases) (no statistically significant difference). It is concluded that the POSSUM scoring system has high value for predicting the risk of morbidity in PD patients.

Value of general surgical risk models for predicting postoperative morbidity and mortality in pancreatic resections for pancreatobiliary carcinomas

“…In contrast, Deyle et al [15] reported that E-PASS was an ineffective predictor of complications following pancreatic resection. Similar contradictive results have been reported on the accuracy of POSSUM models in pancreatic resections [16][17][18][19][20].…”

“…Zhang et al. analyzed 265 cases and revealed that POSSUM overestimated mortality rates especially in low‐risk groups. On the other hand, Pratt et al.…”

“…de Castro et al [18] analyzed 652 cases and found that POSSUM had a significant lack of fit using goodness-of-fit analysis. Zhang et al [19] analyzed 265 cases and revealed that POSSUM overestimated mortality rates especially in low-risk groups. On the other hand, Pratt et al [20] analyzed 326 patients who underwent various pancreatic resections, and revealed that the predicted morbidity rates of POSSUM well correlated with postoperative morbidity and hospital costs.…”

Implementation of an enhanced recovery programme following pancreaticoduodenectomy

“…[13][14][15] Postoperative mortality risk is typically <5% in high-volume institutions, [16][17][18][19][20][21][22][23][24] but morbidity remains high at 30-40%. [24][25][26][27][28][29][30][31][32][33] Relatively few studies have assessed the implementation of an ERAS programme following PD. 19,20,[34][35][36][37][38][39] Some studies have reported the feasibility and effect on reducing postoperative LoS and hospital costs.…”

Does Adding ICU Data to the POSSUM Score Improve the Prediction of Outcomes following Surgery for Upper Gastrointestinal Malignancies?

“…An even larger study on 694 patients focusing on morbidity reported an AUC of 0.64 by POSSUM with significant overestimation of actual risk 14 , in line with the results of this study. In contrast, accurate prediction by POSSUM of morbidity following pancreatic resection has also been reported with an observed to expected morbidity ratio of 0.96 in 326 patients 15 and 0.91 in 265 patients 16 . An important feature of the POSSUM score is the incorporation of physiological, as well as operative, variables.…”