Evaluation of POSSUM and P-POSSUM in Pancreatic Surgery

The POSSUM is a scoring system which is used for estimating mortality and morbidity risk in major operations.Its reliability on predicting and quantifying the impact of complications was proven in previous studies.P-POSSUM is better in predicting mortality after major surgery.The use of POSSUM and PPOSSUM after pancreatic surgery was evaluated previously with varied results.Aim: The aim of the study was to evaluate the use of POSSUM and Portsmouth (P) POSSUM scoring systems to predict postoperative mortality after pancreatic surgery.POSSUM was also evaluated for predicting morbidity and major morbidity after pancreatic surgery.Material and methods: This was a prospective study done in the Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad between Feb 2007 and Jun 2009.POSSUM and P-POSSUM as predictors of morbidity and mortality was analysed.The observed morbidity and mortality were then compared with the predicted figure calculated using POSSUM and PPOSSUM.Linear method of analysis was used to calculate morbidity and mortality.Results: One Hundred and Seven patients underwent elective pancreatic surgeries (pancreaticoduodenectomy in 64) between Feb 2007 to Jun 2009.Possum over predicted mortality (Observed: Expected =0.5:1) and P-POSSUM under predicted mortality (Observed: Expected = 1.5:1) after pancreatic surgery.POSSUM under predicted morbidity (Observed: Expected = 1.6:1).However, when major morbidity alone is taken into consideration POSSUM over predicted mortality (Observed: Expected = 0.7:1).The mean Physiology score and operative score was similar in patients with morbidity and mortality compared with no morbidity and mortality.Similar results were found when only patients with pancreaticoduodenectomy were considered.Conclusion: POSSUM and P-POSSUM did not accurately predict mortality and morbidity in patients undergoing pancreatic surgery.