title: Evaluation of POSSUM for patients undergoing pancreatoduodenectomy.
abstract: BACKGROUND
  Comparison of operative morbidity rates after pancreatoduodenectomy between units may be misleading because it does not take into account the physiological variable of the condition of the patients. The aim of the present study was to evaluate the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) for pancreatoduodenectomy patients and to look for risk factors associated with morbidity in a high-volume center.
  
  
  METHODS
  Between January 1993 and April 2006, 652 patients underwent a pancreatoduodenectomy, 502 of them for malignant disease. POSSUM performance was evaluated by assessing the "goodness-of-fit" with the linear analysis method.
  
  
  RESULTS
  Overall, 332 of the 652 patients (50.9%) had one or more complication after pancreatoduodenectomy, and 9 patients (1.4%) died. POSSUM had a significant lack of fit using goodness-of-fit analysis. In multivariate analysis, one statistically significant factor associated with morbidity and not incorporated in POSSUM (P < 0.05) was identified: ampulla of Vater adenocarcinoma (OR = 1.73, 95% CI: 1.07-2.80).
  
  
  CONCLUSIONS
  Overall, there is a lack of calibration of POSSUM among patients who undergo pancreatoduodenectomy.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. stevedecastro@gmail.com
authors.forename: S M M
authors.initials: SM
authors.lastname: de Castro
authors.forename: J T
authors.initials: JT
authors.lastname: Houwert
authors.forename: S M
authors.initials: SM
authors.lastname: Lagarde
authors.forename: J B
authors.initials: JB
authors.lastname: Reitsma
authors.forename: O R C
authors.initials: OR
authors.lastname: Busch
authors.forename: T M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: H
authors.initials: H
authors.lastname: Obertop
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D009426:Netherlands; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods / Q000401:mortality*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis