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Application of POSSUM and P-POSSUM in Surgical Risk Assessment of Elderly Patients Undergoing Hepatobiliary and Pancreatic Surgery

Authors Hu ZW, Xin RQ, Xia YJ, Jia GP, Chen XX, Wang S

Received 7 May 2020

Accepted for publication 26 June 2020

Published 12 July 2020 Volume 2020:15 Pages 1121—1128

DOI https://doi.org/10.2147/CIA.S258659

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Zhi-Ying Wu


Zhi-Wei Hu, Rui-Qiang Xin, Yi-Jun Xia, Guang-Peng Jia, Xiao-Xu Chen, Shi Wang

Department of Hepatobiliary and Pancreatic Surgery, Inner Mongolia People’s Hospital, Hohhot, Inner Mongolia Autonomous Region, People’s Republic of China

Correspondence: Shi Wang
Department of Hepatobiliary and Pancreatic Surgery, Inner Mongolia People’s Hospital, No. 20 Zhaowuda Road, Hohhot, Inner Mongolia Autonomous Region, People’s Republic of China
Tel +86 18047192834
Fax +86 4713283753
Email 18047192834@163.com

Purpose: To investigate the efficacy and accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) scoring systems in the risk assessment of postoperative complications and death in elderly patients undergoing hepatobiliary and pancreatic surgery.
Patients and Methods: Using POSSUM and P-POSSUM, 274 elderly patients undergoing hepatobiliary and pancreatic surgery were evaluated, and the complications and deaths predicted by the systems were compared with the actual situation. The accuracy and predictive ability of POSSUM and P-POSSUM were evaluated using chi-squared and t-tests, consistency of predicted and actual complication rates (observed/expected, OE ratio), and receiver operating characteristic (ROC) curve.
Results: The complication rate predicted by POSSUM (R1) was 22.57%, while the actual postoperative complication rate was 17.88% (P> 0.05). The mortality rate predicted by POSSUM (R2) was 4.61%, while the actual rate was 1.09% (P< 0.05). The mortality rate predicted by P-POSSUM (R) was 1.42%, while the actual rate was 1.09% (P> 0.05). Patients with complications had higher physiology scores (PS), operative severity scores (OS), and POSSUM scores than those without complications (P< 0.05). Furthermore, PS, OS, and POSSUM scores were higher in the mortality group than in the survival group. However, the number of individuals in the mortality group was too small to accurately reflect the overall situation. Stratified analysis showed that consistency of the OE ratio in different subgroups was close to 1. The ROC curve showed that the area under the curve for the complication rate predicted by POSSUM was 0.76.
Conclusion: Although the postoperative mortality rate was higher than the actual value, POSSUM could accurately predict the postoperative complication rate in elderly patients undergoing hepatobiliary and pancreatic surgery. The P-POSSUM accurately predicted the postoperative mortality rate in this population. Patients with complications had higher POSSUM scores.

Keywords: POSSUM, P-POSSUM, elderly patients, postoperative complication rate, mortality rate

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