Abstract
BackgroundPancreatoduodenectomy (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.MethodA 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.Results30 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.ConclusionP-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
Highlights
Pancreatoduodenectomy (PD) is associated with high incidence of morbidity and mortality
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
P-POSSUM uses the linear method of analysis, which is a standard method described by Hosmer and Lemeshow[17] and the risk assessment applies to an individual patient and is simpler to use[18]
Summary
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. Mortality rates vary widely from 0% to 28% [1,2,3,4], with specialist centres performing high volume surgeries reporting comparatively lower complications and deaths[3]. The incidence of morbidity after PD is still high, even in specialist centres[2,3,5]. The most common outcome measured is mortality. To meaningfully interpret the outcome measurement the incidence of complications following complex operations must be analysed. Crude rates of morbidity and mortality do not (page number not for citation purposes)
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