POSSUM Scoring System Research Articles

Predictive value of POSSUM scoring system for postoperative complications and mortality in elderly patients with colorectal cancer.

The POSSUM scoring system, widely employed in assessing surgical risks, offers a simplified and objective approach for the prediction of complications and mortality in patient. Despite its effectiveness in various surgical fields, including orthopedics and cardiovascular surgery, yet its utilization in elderly patients undergoing colorectal cancer surgery is infrequent. To analyze the predictive value of POSSUM scoring system for postoperative complications and mortality in elderly with colorectal cancer. 306 elderly colorectal cancer patients were grouped according to the complications and death within 30 days after surgery. Among them, 108 cases in complication group, 198 cases in non-complication group, 16 cases in death group and 290 cases in survival group. POSSUM scores of all subjects were obtained and its predictive value for postoperative complications and mortality of elderly was conducted by ROC curve. No apparent difference were observed in complications and mortality among patients with different disease types, operation types and operation timing (P> 0.05). The R2 in complication group was higher than non-complication group (P< 0.05). The R1 in death group were higher than survival group (P< 0.05). The AUC of R2 for predicting postoperative complications was 0.955 with a sensitivity of 88.89% and a specificity of 94.44% and the AUC of R1 for evaluating postoperative mortality of elderly with colorectal cancer was 0.783 with a sensitivity of 56.25% and a specificity of 82.93%. POSSUM score system has a certain predictive value for postoperative complications and mortality in elderly with colorectal cancer. However, the predicted mortality rate is higher than actual mortality rate.

Evaluation of Possum and P Possum Scoring Systems in Patients Undergoing Emergency Abdominal Surgeries

Evaluation of Possum and P Possum Scoring Systems in Patients Undergoing Emergency Abdominal Surgeries

POSSUM scoring in hollow viscus perforation at National Medical College and Teaching Hospital, Nepal

Background: Peritonitis as a result of hollow viscus perforation is a common condition in developing countries like Nepal where post-operative period is unpredictable even if patient reaches hospital in time and being operated. Physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) helps to identify patients at increased risk of developing deaths and complications. It is based on 12 physiological and 6 operative parameters. Methods: A total of 50 patients of hollow viscus perforation admitted and operated at National Medical College and Teaching Hospital Birgunj, Nepal from July 2020 to June 2021 were included in study. It was a prospective observational study. Results: During the study 9 patients died and the observed to expected ratio (O: E) 0.3 was obtained. Out of 41 patients who survived 28 suffered complications an observed to expected ratio (O: E) of 0.68 was obtained. Conclusions: POSSUM scoring system is reliable for predicting post-operative morbidity and mortality and helps to improve prognosis of patients operated for perforated hollow viscus.

EVALUATION AND OUTCOME OF EMERGENCY GIT SURGERIES

Background: Emergency gastrointestinal surgeries are frequently performed procedure which have mortality and morbidity much more than that of elective surgery, they carry a substantial risk of operative and postoperative complications and death. A system was developed to allow for the rst time an assessment of surgical quality that was risk adjusted for the patient's acute and chronic physiological status and for the nature of operation. The POSSUM audit system was designed to be easy and rapid to use and to have wide application across the general surgical spectrum both in the elective and emergency settings. Our study was conducted on 96 Pat Methods: ients of acute abdomen and blunt injury undergoing emergency GIT surgery and patients which develop postoperative complications admitted in department of surgery, RD Gardi Medical College,Ujjain between November 2018 to April 2020 Our study Signies that Forty-thre Results: e percent patients had morbidity in these group of patients, among which wound related complication has the predominant cause of morbidity, pulmonary complication were also common. In total eight patients died in patients undergoing emergency laparotomy four because of of MODS three due to SIRS and one due to sepsis. In our study, ve patients had cardiac risk . Respiratory signs were more prevalent seventeen patients having them, Blood loss was also higher with eleven patients having more than 1000 ml blood loss. Peritoneal soiling was also very common, with thirty seven patients having localised pus collections in forty-one, spillage of bowel contents seen in seventeen patients and hemoperitoneum in four patients Recognizing Conclusions. patients who are at high risk to develop complications and who have high risk of mortality would prompt us to take necessary and timely action and aid us in the better management of the patient. POSSUM mortality equation over predicts mortality especially in low risk groups, while predictive value improves signicantly when exponential analysis is used.Hence POSSUM scoring system has an undeniable advantage in our set up for better patient counseling, improving the surgical outcomes in emergency wards and for better management of limited resources and manpower.

PREDICTORS OF POST OPERATIVE MORTALITY AND MORBIDITY USING THE PPOSSUM SCORING SYSTEM IN GENERAL SURGICAL PATIENTS

Introduction: The risk scoring system in all elds of medicine is gaining popularity in order to assess the outcome and improve the patient care. Various scoring systems are available to predict the surgical outcome, but most of them fail to incorporate surgical factors. Portsmouth Physiological and Operative Severity Scores for the enumeration of Mortality and Morbidity (P-POSSUM) scoring system help in predicting the outcome in the surgical patients. This study was conducted to evaluate the validity of P- POSSUM in patients undergoing major surgery and to enumerate the risk factors for low outcome in our setup. Methods: A longitudinal observational study on 250 consenting patients who underwent medium, major and major + surgeries as dened by POSSUM scoring system. Data was collected as per 12 physiological and 6 operative factors to obtain P-POSSUM scores and statistical analysis was done to compare the actual and predicted mortality. Result: The predicted mortality score was statistically signicant in predicting the death (p- 0.0004). Among all the risk factors studied, 12 physiological and the 5 operative parameters had a signicant contribution towards predicting the post operative mortality. A threshold score beyond which the mortality can be predicted was also obtained by plotting the ROC curve. Conclusion: This study validates P-POSSUM scoring system accurately in predicting mortality in patients who underwent major surgical procedures in our setup and helped in identifying the factors responsible for the poor outcome.

Evaluation of POSSUM Score for Outcome Prediction in Patients undergoing Major Gastrointestinal Surgery in Population of Central Nepal

Introduction: The POSSUM score is one of the several risk scores to predict postoperative morbidity and mortality in the surgical domain.This study was designed to assess the validity of POSSUM scoring system in patients undergoing gastrointestinal surgeries in our setup and to analyse the outcome and compare the observed and expected values. Methods: An analytical cross sectional study was conducted among 100 patients in the Department of Surgical Gastroenterology after taking ethical approval from COMS-IRC. Data was analysed using SPSS -20 via descriptive and inferential statistical tools. p-value &lt;0.05 was considered statistical significant. Results: Using POSSUM score the expected morbidity was 54% and mortality was 21.47%.The observed morbidity was 54% and mortality was 13%. The observed to expected (O: E) morbidity was 1.03 and mortality was 0.61 and there was no statistically significant difference between observed and expected value. The area under curve for POSSUM mortality score was 0.896 and the sensitivity and specificity of POSSUM score to predict mortality was 93.2 and 83.9 respectively. Conclusions: POSSUM score is a good mathematical tool in predicting morbidity and mortality in patients undergoing gastrointestinal surgeries. Keywords: gastrointestinal surgeries; central Nepal; expected morbidity and mortality; observed morbidity and mortality; POSSUM score.

Efficacy of POSSUM for risk adjusted surgical audit of patients undergoing emergency laparotomy

Background: The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is extensively used to predict mortality and morbidity in various surgical procedures and good tool for comparison and risk adjustment. This study was designed to assess the efficacy of POSSUM scoring system by comparing expected and observed rates of morbidity and mortality in cases undergoing emergency laparotomy Methods: A resource of 114 cases undergoing emergency laparotomy within 24 hours of admission at Government Medical College and Hospital, Nizamabad were recruited. The details of physiological variables and intraoperative variables of consented participants were recorded. The POSSUM score was used to predict morbidity and mortality rate. Results: Among the observed cases, 80.48% had no morbidity. Among the predicted cases, 85.96% of cases may expect morbidity. Among the death, 69.23% was observed as mortality. The overall expected mortality in observed and predicted cases was 94.73%. There is no statistical significance in the morbidity (chi-square value - 7.252, p=0.443) and mortality (chi-square value - 1.357, p=0.129). Conclusion: The POSSUM is important and most reliable for predicting postoperative mortality and morbidity in cases undergoing emergency laparotomy.

P-POSSUM for onco-surgeries: Does one suit fits all!

The prediction of outcome after major oncological surgeries is always useful for clinicians. It helps in various decisions making like judicious use of resources, patient counseling, perioperative planning etc. This issue publishes an interesting retrospective study titled “Validity of P-POSSUM in Adult Cancer Surgery (PACS)”.[1] It would be prejudiced to assume that the P-POSSUM scoring is ineffective in predicting the outcomes accurately as there are various confounding factors in its implementation in the cohort of heterogeneous surgeries. The postoperative morbidity and mortality in patients undergoing onco-surgeries not only depends on noted 18 parameters (12 physiological factors and 6 operative factors) but also many other parameters. P-POSSUM includes the presence of malignancy as one of the operative factors for predicting the outcome. The outcome in onco-surgeries shall depend on various factors like patient physical status and preoperative cancer treatment like radiotherapy or chemotherapy.[2] These factors would affect the various body physiology and thus would affect the overall perioperative outcome. These factors need to be considered for prediction mortality. Probably, these concerns have motivated researchers to look for other models and have modified the existing prediction models like CR-POSSUM, etc. The perioperative outcome may also be related to the type and site of surgeries. Hence, homogenous, standardized and consistent outcome measures like scoring system may provide more accurate risk prediction.[34] Considering these facts, modified POSSUM scoring system have been developed for sub-specialty surgeries, namely, CR-POSSUM for colorectal surgeries, O-POSSUM for surgery on esophagus, etc. The use of various risk prediction models have their limitations, may over-predict complications/morbidity and thus their usage in clinical practice has mixed opinions. One of the reasons remains inclusion of primarily patient-related factors with some additional intraoperative factors. The outcome after onco-surgery is also related to gender, requirement of blood transfusion, site of lesion, timing of surgery, pre-operative serum brain natriuretic protein level and postoperative factors like blood transfusion, infections, surgical complications etc.[56] Many of the included factors like blood loss during surgery need to be specified for objective assessment. There is an ambiguity in timing of preoperative evaluation and it does not consider the presence of various comorbidities, whether optimized preoperatively or not. The postoperative outcome is also related to surgical technique and this consideration is absent in many of the existing prediction models. It has been reported that the use of minimally invasive procedures like laparoscopic or robotic techniques has a better postoperative outcome compared to open major surgeries but prediction using POSSUM, and CR-POSSUM has overestimated the predicted outcome.[789] The prediction models such as POSUM predicts morbidity without any attribution to a specific cause. This fact limits the clinical utility for decreasing cause-specific morbidity in the postoperative period. Hence, a risk-adjusted prediction model would be desirable to identify for the probability of specific complications.[910] The Clavien-Dindo classification is a standardized system of grading the severity of complications based on treatment and therapy to manage complications.[1112] The authors have used this scoring system, which is an objective method of categorizing postoperative complications, preventing the subjective classification of minor or major complications. However, the perioperative complications need to be stratified further like localized, systemic or those requiring immediate intervention.[91012] Such categorization would be helpful for auditing the care and steps required for improving such occurrence.[13] To summarize, P-POSSUM scoring system has evolved as a statistical tool that can be used for performance evaluation of various types of surgical procedures. It predicts the estimated operative mortality rates as an objective measure of outcome assessment. Its limitation needs to be understood in the context of specific surgeries and score interpreted accordingly. More precise and better prediction tools are desirable inclusive of factors related to particular surgical procedure.

Prediction of Mortality in Patients After Oncologic Gastrointestinal Surgery: Comparison of the ASA, APACHE II, and POSSUM Scoring Systems.

Scoring systems have been developed to predict the expected mortality and morbidity in surgical procedures. In this study, our aim was to compare the ASA (American Society of Anesthesiologists), APACHE (Acute Physiology and Chronic Health Evaluation) II, POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) scoring systems as predictors of mortality in patients who underwent gastrointestinal oncologic surgery, followed, and were admitted to the intensive care unit during the postoperative period. We examined the files of 82 patients who underwent oncologic gastrointestinal surgery and followed up in the intensive care units (ICUs). The patients’ APACHE II scores and predicted mortality rates (PMR) according to the APACHE II, POSSUM, and ASA scores were ​​calculated. The receiver operator characteristic (ROC) curve analysis was used when evaluating the performances of the ASA, APACHE, and POSSUM scoring systems in terms of accurate assessment of mortality. Accordingly, the area under the curve (AUC) = 0.5 no distinction, 0.5 <AUC <0.7 discriminative power of the test is statistically not significant, 0.7 <AUC <0.8 acceptable, 0.8 <AUC <0.9 very good and 0.9 <AUC <1 perfect. The evaluations showed that APACHE II had the best performance with 0.81, followed by POSSUM, which had an acceptable level at 0.78. On the other hand, the ASA score was 0.63 and its discriminative power was identified as statistically insignificant. Our results show that the POSSUM and APACHE II scoring systems were better at predicting mortality than the ASA scoring system for the prediction of mortality in the postoperative period. Both the POSSUM and APACHE II scoring systems can be confidently used for the prediction of mortality in patients undergoing operations due to oncologic gastrointestinal diseases.

Surgical Evaluation of P-Possum and Cr-Possum Scores in Patient Undergoing Colorectal Cancer Operation

Background: "Portsmouth" modification of POSSUM (P-POSSUM) scoring system used to assess mortality in general surgical patients and “Colorectal” Cr-POSSUM scoring system used for mortality assessment for colorectal patient.&#x0D; Objective: The purpose of the present study was to estimate the validity of the P-POSSUM (Portsmouth-POSSUM) and Cr-POSSUM (Colorectal-POSSUM) score in predicting the risk of mortality in colorectal cancer patient.&#x0D; Methodology: This was single centre clinical trial was carried out in the Department of Surgery at Dhaka Medical College Hospital, Dhaka, Bangladesh from November 2013 to April 2014 for a period of six (06) months. Patients of both sex who got admitted in the surgery in-patient department for elective colorectal cancer operations were selected as study population. Both the P-POSSUM and Cr-POSSUM, physiological score, operative score, predicted mortality rate were calculated using an online POSSUM calculator. Based on both P-POSSUM and Cr-POSSUM Scoring, patients were categorized into three risk groups. Then a comparative analysis was performed between the observed and the predicted values as well as the Observed/Predicted ratio (O:P) in all the risk groups.&#x0D; Results: A total of 50 patients with the median age of 50 (ranging 20 to 72) years were studied. 30 days overall observed mortality was 3(6%) patients. The mean P-POSSUM and C-POSSUM physiological scores were 32.49±2.08 and 13.92±1.30 respectively. However, the operative score was 11.59±1.46 and 8.12±0.24 in P-POSSUM and C-POSSUM respectively. The overall mortality predicted by the P-POSSUM model was 5 patients (19.33±2.87) and mortality predicted by the Cr-POSSUM model was 4 patients (20.66±4.09).&#x0D; Conclusion: In conclusion both model accurately predicted the risk of postoperative death. Cr-POSSUM provided a better fit to observed results than P-POSSUM.&#x0D; Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 118-123

A newly improved POSSUM scoring system for prediction of morbidity in patients with pancreaticoduodenectomy.

BackgroundPostoperative morbidity of pancreaticoduodenectomy (PD) is still prevalent in hospitals around the world all over the world. Chirurgia B and Chen Yingtai et al. compared the existing POSSUM and p-POSSUM scoring system in pancreatoduodenectomy. However, in this retrospective cohort study our aim was to investigate the risk factors associated with post-PD complications, and develop a POSSUM scoring system more specific to PD, which we define as PD-POSSUM.MethodsData was gathered from 201 patients who underwent PD procedure at No.4 Hospital of Hebei Medical University between January 2016 and December 2018. All 201 patients were included in the modeling group. The morbidity and associated risk factors were collected and analyzed. The risk factors of complication were investigated by the Pearson χ2 test, Spearman rho test, multivariable linear regression, univariate/multivariate logistic regression. In addition, the discriminating ability of the PD-POSSUM system to predict morbidity is estimated by the area under the receiver operating characteristic curve (ROC-AUC).ResultsMorbidity was 45.5% for the 201 patients. Multivariate logistic regression analysis demonstrated a significant connection between postoperative complications and body mass index (BMI) [odd ratio (OR): 3.700; 95% confidence interval (95% CI): 1.594–4.572], pre-existing respiratory diseases (OR: 3.000; 95% CI: 1.542–5.837), international normalized ratio of prothrombin time (OR: 0.321; 95% CI: 0.099–1.038), alanine aminotransferase (OR: 0.573; 95% CI: 0.375–0.874); total bilirubin level (OR: 1.477; 95% CI: 1.068–2.043); diameter of pancreatic duct (OR: 1.837; 95% CI: 1.221–2.763) and diameter of tumor diameter (OR: 1.837; 95% CI: 1.221–2.763).Conclusions This risk assessment formula can help estimate and predict postoperative morbidity rate after PD.

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.

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. 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. 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. 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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Evaluation of POSSUM scoring systems in predicting postoperative morbidity and mortality in indian patients operated for esophageal cancer

Background: Surgical treatment for esophageal cancer is a high-risk procedure. Prediction of postoperative adverse events could aid in the stratification of patients, thus improving outcomes as well as achieving optimal use of resources. The Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) is a prediction model that utilizes both physiological and surgical parameters to assess risk. This study evaluates the effectiveness of POSSUM, Portsmouth-POSSUM (P-POSSUM), and esophagogastric-POSSUM (O-POSSUM) scoring systems in predicting postoperative morbidity and mortality in Indian patients operated for esophageal cancers. Patients and Methods: It is a retrospective study conducted in a tertiary care teaching hospital with data collected from esophagectomies performed from January 2015 to January 2019. The calibration and discriminative abilities of the scores to predict 30-day morbidity and mortality were analyzed using the Hosmer–Lemeshow test, observed to predicted ratios (observed/expected [O/E]), and the receiver operating characteristic curve tests. Results: A total of sixty patients were included. The 30-day mortality and morbidity were 6.67% (4/60) and 46.66% (28/60), respectively. POSSUM morbidity showed proper calibration and discrimination (O/E: 0.86) with a modest predictive ability (area under the curve [AUC]: 0.701). While analyzing mortality, though all scores displayed good calibration, O-POSSUM displayed superior predictive ability (O/E: 1.02). The POSSUM score overpredicted mortality by nearly twice (O/E: 0.52), whereas P-POSSUM underpredicted it (O/E: 1.71). All scores showed moderate discrimination with P-POSSUM outperforming other tests (AUC: 0.825). Conclusions: The POSSUM scoring system was useful in predicting morbidity risk following esophageal resection for cancer, with O-POSSUM more accurate for mortality prediction in this group of patients.

Efficacy of POSSUM scoring system in predicting mortality among patients undergoing laparotomy for peritonitis

Efficacy of POSSUM scoring system in predicting mortality among patients undergoing laparotomy for peritonitis

Evaluation of possum scoring system in patients undergoing laparotomy

Background: Prediction of complications is an essential part of risk management in surgery. Knowing which patient is at risk of developing complications contributes to the quality of surgical care and cost reduction in surgery. Among the variety of scoring systems used to identify the “high risk” patient POSSUM scoring is the most widely used.Methods: Patients undergoing laparotomy were selected serially and their physiological severity score on admission and operative severity scored at the end of 30days and compared with the POSSUM predicted score.Results: In the elective surgery group, patients with morbidity correlated with high POSSUM scores but due to low overall morbidity conclusions could not be drawn while in the emergency group predicted morbidity correlated well with observed results. The low overall mortality in the study group precluded meaningful analysis.Conclusions: POSSUM scoring system has an undeniable advantage in this set up for better patient counseling, improving the surgical outcomes in both emergency and elective wards and for better management of limited resources and manpower.

CR-Possum-Can It Be Used to Predict Morbidity? A Single-Centre Retrospective Study.

Preoperative prediction of morbidity in colorectal cancer (CRC) surgery helps to optimize the surgical outcome. In this study, we aim to develop a dedicated equation for predicting operative morbidity using colorectal possum scoring system and also to validate the predictive accuracy of CR-POSSUM scoring system in prognosticating actual complications. We did a retrospective analysis of 322 patients undergoing colorectal cancer surgery from a single centre in South India from 2004 to 2016. Mortality and morbidity risk factors as defined by CR POSSUM were collected from 322 patients who underwent CRC surgery and were used to derive equations to predict morbidity, and the results were compared with the observed morbidity. Logistic regression analysis was used to derive the equation. The model fit and model discrimination were analysed using the Hosmer-Lemeshow statistical test for goodness of fit, the Nagelkerke R 2 and area under the receiver operating characteristic (ROC) curve respectively. Out of 322 patients, 103 (32%) patients developed complications and 10 (3%) died due to complications. The regression equation we derived has an overall correct classification of about 70% (P < 0.01) with positive and negative predictive value of 60% and 73% respectively. The Hosmer-Lemeshow goodness of fit was 3.147 (P = 0.829), and the Nagelkerke R 2 was 17% and area under ROC as model discrimination was 71.6%. Hence, CR-POSSUM scoring which was originally used for predicting mortality risk can also be extrapolated to predict morbidity.

Efficacy of Possum in Surgical Audit of Patient Undergoing Emergency Surgery at Nepalgunj Medical College

Introduction: The Physiological and Operative Severity Score for the en Umeration of Mortality and morbidity (POSSUM) has been proposed as a method for standardizing patient data so that direct comparisons can be made in spite of differing patterns of referral and population.Aims and objectives: To evaluate the efficacy of a scoring system for predicting the incidence of postoperative complications and mortality in patient undergoing Emergency Surgeries based on the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM).Material and Methods: This is a hospital based cross sectional study of all the cases that had undergone Emergency Surgery at Nepalgunj Medical College Teaching Hospital from the period of July 2014 to June 2015. The period of follow up was 30 days following the surgical procedure? A total of 100 emergency surgeries, as defined by the POSSUM scoring system criteria were studied. Predicted mortality and morbidity rates were calculated using the POSSUM equation by exponential analysis method. It was then compared with the actual outcomes. Observed: Expected Ratio (O:E) was calculated and difference detected by chi-square test. The risk factors as scored in the POSSUM criteria were noted.Results: Applying exponential analysis, an observed to expected ratio (O:E) for mortality of 0.44 was obtained, indicating significant 2 difference between the predicted and observed values (x =93.207, df 63, p=0.008). But, an observed to expected ratio (O:E) for 2 morbidity of 1.01 was obtained and there was no significant difference between the predicted and observed values (x =76.295, df 71, p=0.312). It was found to be comparable to other studies. In all the risk factors studied, a positive correlation was found between deaths and post-operative complications with higher POSSUM scores.Conclusion: POSSUM scoring system could accurately predict overall morbidity while it over predicted the overall mortality. POSSUM scoring system serves as a good predictor of post-operative outcome in major general surgical procedures and was applicable even in our setup and be used for comparing various treatment modalities and assessing the quality of care provided. JNGMC Vol. 14 No. 2 December 2016, page: 2-7

Good overall morbidity prediction with the POSSUM scoring system in patients having a total hip or knee replacement - a prospective study in 227 patients.

PurposeThe Physiological and Operation Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and P (Portsmouth)-POSSUM predict the risks of complications and mortality 30 days after surgery. The purpose of this study was to evaluate the POSSUM and P-POSSUM scoring systems in patients who underwent surgery for a total hip or knee replacement.Patients and methodsA total of 227 patients with an elective primary total hip or knee replacement were included. The predicted postoperative morbidity was analyzed in these patients and compared with the observed value 30 days after surgery. Logistic regression analysis was used to assess the correlation of variables and outcome.ResultsThe number of patients undergoing total hip or knee replacement was equally distributed with a mean age of 66.4±12.5 years; 57% of patients were females. Postoperative complications occurred in 49 patients, and POSSUM predicted 49 cases with an observed-over-expected ratio of 1.0. The average total POSSUM score was 27.4±4.4 in patients with complications and 26.8±3.5 in patients without complications (P=0.340). Wound infection (n=18), urinary tract infection (n=7), and pulmonary embolus (n=5) were the most common complications. The operation magnitude variable had the highest mean POSSUM score making it the most relevant variable. Age and blood loss and echocardiogram had the largest variance among the assessed variables.ConclusionPOSSUM accurately predicted morbidities in patients undergoing elective primary total hip or knee replacement. The risk for wound infection, urinary retention, and pulmonary embolus should be considered during hospitalization. The computerized POSSUM system provides case-mix-adjusted morbidity predictions for groups and, hence, serves as a useful tool for surgical audits and large-scale benchmarking.

Perioperative risk prediction in the era of enhanced recovery: a comparison of POSSUM, ACPGBI, and E-PASS scoring systems in major surgical procedures of the colorectal surgeon

PurposeThis study aims to determine whether traditional risk models can accurately predict morbidity and mortality in patients undergoing major surgery by colorectal surgeons within an enhanced recovery program.MethodsOne thousand three hundred eighty patients undergoing surgery performed by colorectal surgeons in a single UK hospital (2008–2013) were included. Six risk models were evaluated: (1) Physiology and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), (2) Portsmouth POSSUM (P-POSSUM), (3) ColoRectal (CR-POSSUM), (4) Elderly POSSUM (E-POSSUM), (5) the Association of Great Britain and Ireland (ACPGBI) score, and (6) modified Estimation of Physiologic Ability and Surgical Stress Score (E-PASS). Model accuracy was assessed by observed to expected (O:E) ratios and area under Receiver Operating Characteristic curve (AUC).ResultsEleven patients (0.8%) died and 143 patients (10.4%) had a major complication within 30 days of surgery. All models overpredicted mortality and had poor discrimination: POSSUM 8.5% (O:E 0.09, AUC 0.56), P-POSSUM 2.2% (O:E 0.37, AUC 0.56), CR-POSSUM 7.1% (O:E 0.11, AUC 0.61), and E-PASS 3.0% (O:E 0.27, AUC 0.46). ACPGBI overestimated mortality in patients undergoing surgery for cancer 4.4% (O:E = 0.28, AUC = 0.41). Predicted morbidity was also overestimated by POSSUM 32.7% (O:E = 0.32, AUC = 0.51). E-POSSUM overestimated mortality (3.25%, O:E 0.57 AUC = 0.54) and morbidity (37.4%, O:E 0.30 AUC = 0.53) in patients aged ≥ 70 years and over.ConclusionAll models overestimated mortality and morbidity. New models are required to accurately predict the risk of adverse outcome in patients undergoing major abdominal surgery taking into account the reduced physiological and operative insult of laparoscopic surgery and enhanced recovery care.