Application of Portsmouth modification of physiological and operative severity scoring system for enumeration of morbidity and mortality (P-POSSUM) in pancreatic surgery.
BACKGROUND
Pancreatoduodenectomy (PD) is associated with high incidence of morbidity and mortality. We have applied P-POSSUM in predicting the incidence of outcome after PD to identify those who are at the highest risk of developing complications.


METHODS
A prospective database of 241 consecutive patients who had PD from January 2002 to September 2005 was retrospectively updated and analysed. P-POSSUM score was calculated for each patient and correlated with observed morbidity and mortality.


RESULTS
30 days mortality was 7.8% and morbidity was 44.8%. Mean physiological score was 16.07 +/- 3.30. Mean operative score was 13.67 +/- 3.42. Mean operative score rose to 20.28 +/- 2.52 for the complex major operation (p < 0.001) with 2 fold increase in morbidity and 3.5 fold increase in mortality. For groups of patients with a physiological score of (less than or equal to) 18, the O:P (observed to Predicted) morbidity ratio was 1.3-1.4 and, with a physiological score of >18, the O:P ratio was nearer to 1. Physiological score and white cell count were significant in a multivariate model.


CONCLUSIONS
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.
Tamijmarane
Appou
A
Queen Elizabeth hospital, liver unit, Birmingham, UK. appou.tamijmarane@gmail.com
Bhati
Chandra S
CS
Mirza
Darius F
DF
Bramhall
Simon R
SR
Mayer
David A
DA
Wigmore
Stephen J
SJ
Buckels
John Ac
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019992:Databases as Topic; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D015994:Incidence; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010179:Pancreas / Q000503:physiopathology / Q000601:surgery*; D010182:Pancreatic Diseases / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index