Is POSSUM predictive of morbidity and mortality in laryngectomy patients?

Lancaster, Jeffery; Jones, Bethan F.; Ghosh, Samit; Tandon, Sankalap; Kinshuck, Andrew; Goodyear, P; Roland, N J; Jackson, Sarah; Jones, Terry M.

doi:10.1016/j.anl.2010.12.001

Cited by 5 publications

(11 citation statements)

References 22 publications

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“…Overall mortality in this cohort was 2.78%. This is in keeping with published mortality rates following laryngectomy in the UK, France and the USA ranging from 1.2% to 4.8% . The ACS‐NSQIP calculator performed very well when predicting mortality in South Australian patients.…”

Section: Discussionsupporting

confidence: 85%

National Surgical Quality Improvement Program risk calculator validity in South Australian laryngectomy patients

Kao

Frauenfelder

Wong

et al. 2020

ANZ Journal of Surgery

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Background: Assessing an individual patient's post-operative risk profile prior to laryngectomy for cancer is difficult. The American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) risk calculator was developed to better inform preoperative decision-making. The calculator uses patient-specific characteristics to estimate the risk of experiencing post-operative complications within 30 days of surgery. We investigated the ACS-NSQIP risk calculator's performance for Australian laryngectomy patients. Methods: The ACS-NSQIP risk calculator was used to retrospectively calculate the 30-day post-operative predicted outcomes in patients who underwent laryngectomy for laryngeal, hypopharyngeal and thyroid cancers (with laryngeal involvement) in two institutions in South Australia. These data were compared against the actual mortality, morbidity, complications and length of stay (LOS) collected from a retrospective chart review. Results: A total of 144 patients underwent surgical intervention for malignancies with laryngeal involvement. The median LOS was 25 days (range 13-197) compared to the predicted LOS of 6.5 days (range 3.5-12.5). Overall mortality was 2.78% with postoperative complications occurring in 63% of patients. The most common complication was wound infection, occurring in 33% of patients. Hosmer-Lemeshow plots demonstrated good agreement between predicted and observed rates for complications. Conclusion: The ACS-NSQIP risk calculator effectively predicted post-operative complication rates in South Australian laryngeal cancer patients undergoing laryngectomy. However, differences in predicted and actual LOS may limit the usefulness of the calculator's LOS predictions for Australian patients. © 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 740-745 ANZJSurg.com

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Section: Discussionsupporting

confidence: 85%

National Surgical Quality Improvement Program risk calculator validity in South Australian laryngectomy patients

Kao

Frauenfelder

Wong

et al. 2020

ANZ Journal of Surgery

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“…Our study had the largest sample size as compared to all previous studies. 9,14,15 Various authors have observed a low mortality (<3%) in their study cohort. However we did not observe any 30-day mortality in our study cohort against an expected mortality of 16.54% by POSSUM mortality model and 5.45% by P-POSSUM mortality model.…”

Section: Morbidity Prediction Modelmentioning

confidence: 80%

“…Majority of our patients were male, similar to other studies which included head and neck cancer surgery patients. 9,15,16 Our study population was relatively younger as compared to other studies. 16 In the current study, majority of patients were diagnosed to have oral cavity lesions followed by thyroid cancer as opposed to other studies which included only specific primary sites hence our study has data related to a broad spectrum of head and neck oncosurgeries.…”

Section: Discussionmentioning

confidence: 90%

“…16 In the current study, majority of patients were diagnosed to have oral cavity lesions followed by thyroid cancer as opposed to other studies which included only specific primary sites hence our study has data related to a broad spectrum of head and neck oncosurgeries. 9,15,16 We included only elective surgeries that is, if a patient underwent a redo surgery for complication of primary surgery it was not included as surgery but as morbidity. We found that the 30-day morbidity was 33% for the entire cohort, while it was 34.77% for our subgroup, and 30-day mortality was 0%, in both cohorts, unlike other studies.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2020

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Background Identification of risk factors for perioperative complications helps in the prognostication. We wanted to determine whether Physiological and Operative Severity Score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth‐POSSUM (P‐POSSUM) can be used in patients undergoing head and neck oncosurgery. Methods We conducted a retrospective analysis of 1265 patients after they had major head and neck oncosurgeries. Demographic, surgical and outcome data was collected. We separately analyzed data for patients who had undergone cancer surgery for oral cavity, pharynx, and larynx. We calculated the POSSUM and P‐POSSUM scores. Results POSSUM scoring system had moderate discrimination (AUC = 0.61) and good calibration (P = .36) for the entire study cohort and in the subgroup. Since there were no deaths in the entire cohort, we were not able to check predictive ability of the scores, for mortality. Conclusions We found that POSSUM had moderate discrimination and good calibration for morbidity prediction in head and neck cancer surgeries, as well as for the selected subgroup.

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

Makino

Ishida

Kishi

et al. 2017

Journal of Plastic Surgery and Hand Surgery

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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.

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Is POSSUM predictive of morbidity and mortality in laryngectomy patients?

Cited by 5 publications

References 22 publications

National Surgical Quality Improvement Program risk calculator validity in South Australian laryngectomy patients

National Surgical Quality Improvement Program risk calculator validity in South Australian laryngectomy patients

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

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

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