title: Estimation of mortality and morbidity risk of radical cystectomy using POSSUM and the Portsmouth predictor equation.
abstract: BACKGROUND
  The Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) and the Portsmouth predictor equation (P-POSSUM) are simple scoring systems used to estimate the risk of complications and death postoperatively. We investigated the use of these scores to predict the postoperative risk in patients undergoing radical cystectomy (RC).
  
  
  METHODS
  In this retrospective study, we enrolled 280 patients who underwent RC for invasive bladder cancer between January 2003 and December 2011. Morbidity and mortality were predicted using the POSSUM and P-POSSUM equations. We further assessed the ability of the POSSUM and P-POSSUM to predict the mortality and morbidity risk in RC patients with a Clavien-Dindo classification of surgical complications of grade II or higher.
  
  
  RESULTS
  The observed morbidity and mortality rates were 58.9% (165 patients) and 1.8% (5 patients), respectively. Predicted morbidity using POSSUM was 49.2% (138 patients) compared to the 58.9% (165 patients) observed (P <0.0001). Compared to the observed death rate of 1.8% (5 patients), predicted mortality using POSSUM and P-POSSUM was 12.1% (34 patients) and 3.9% (11 patients), respectively (P <0.0001 and P = 0.205). The mortality risk estimated by P-POSSUM was not significantly different from the observed mortality rate.
  
  
  CONCLUSIONS
  The results of this study supported the efficacy of POSSUM combined with P-POSSUM to predict morbidity and mortality in patients undergoing RC. Further prospective studies are needed to better determine the usefulness of POSSUM and P-POSSUM for a comparative audit in urological patients undergoing RC.
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Masago
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Morizane
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Honda
authors.affiliation: Division of Urology, Tottori Prefectural Central Hospital, Tottori, Japan.
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Isoyama
authors.affiliation: Division of Urology, Japanese Red Cross Society Matsue Hospital, Matsue, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Koumi
authors.affiliation: Division of Urology, Japanese Red Cross Society Tottori Hospital, Tottori, Japan.
authors.forename: Kouji
authors.initials: K
authors.lastname: Ono
authors.affiliation: Division of Urology, Saninrousai Hospital, Yonago, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kadowaki
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Sejima
authors.affiliation: Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takenaka
keywords: P-POSSUM; POSSUM; invasive bladder cancer; morbidity; radical cystectomy