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

Abstract

Aims: To evaluate the role of the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM), the Portsmouth variant (p-POSSUM) and the Glasgow Prognostic Score (GPS) in predicting outcome after pancreatic surgery with reference to the International Study Group of Pancreatic Surgery (ISGPS) definitions of post-pancreatectomy complications. Methods: All consecutive patients undergoing major pancreatic resection over a 32- month period were included. POSSUM, p-POSSUM and GPS score were calculated for each patient and correlated against the observed mortality and morbidity using the ISGPS definitions. Results: The observed:expected ratios for POSSUM mortality, POSSUM morbidity and p-POSSUM mortality were 0.24 (p < 0.0001), 0.86 (p < 0.0001) and 0.79 (p = 0.09), respectively. POSSUM had a ‘poor fit’ with respect to predicting morbidity (χ² = 16.4, 8 d.f., p = 0.04). Multifactorial regression analysis revealed the GPS as an independent predictor of post-operative outcome (GPS 1, p = 0.03, OR 2.99, 95% CI 1.4–7.9, and GPS 2, p = 0.02, OR 4.3, 95% CI 1.8–15.5). Conclusion: POSSUM has a limited role as an outcome score in pancreatic resection. The GPS may be a novel alternative to POSSUM as a pre-operative predictor of outcome.

Cardiopulmonary Exercise Testing for Preoperative Risk Assessment before Pancreaticoduodenectomy for Cancer

“…In this subset, preoperative functional status was assessed using the American Society of Anaesthesiologists (ASA) score and the six-point Revised Cardiac Risk Index (RCRI); including high-risk surgical procedure, history of ischaemic heart disease, history of heart failure, cerebrovascular disease, insulin dependent diabetes and preoperative serum creatinine concentration ≥177 μmol/L. Other predictors of postoperative risk including body mass index (BMI) and the Glasgow Prognostic Score (GPS) [11] were collected prospectively to permit comparison with CPET data.…”

“…Postoperative morbidity was defined using the International Study Group [11] for Pancreatic Surgery (ISGPS) classification for post-pancreaticoduodenectomy complications of postoperative pancreatic fistula (POPF) [12] delayed gastric emptying (DGE) [13] and post-pancreaticoduodenectomy haemorrhage (PPH) [14]. Cardiac complications included acute myocardial infarction (detection of a rise in serum troponin) and electrocardiographic (ECG) changes indicative of new ischaemia; congestive cardiac failure and, serious dysrhythmia resulting in compromised tissue perfusion and primary cardiac arrest.…”

Pre-operative cardiopulmonary exercise testing predicts adverse post-operative events and non-progression to adjuvant therapy after major pancreatic surgery

“…More recently, there has been some evidence that the presence of an ongoing systemic inflammatory response before surgery is associated with the development of post‐operative complications in patients undergoing surgery for colorectal cancer, oesophageal cancer as well as pancreatic cancer …”

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.…”