Evaluation of P-POSSUM Risk Scoring System in Prediction of Morbidity and Mortality after Pancreaticoduodenectomy

Chirurgia (Bucur). 2018 May-Jun;113(3):399-404. doi: 10.21614/chirurgia.113.3.399.

Abstract

Background: POSSUM and P-POSSUM are risk scores recommended by ERAS Society for the preoperative evaluation of patients undergoing major surgery. Methods: This study includes 113 consecutive pancreaticoduodenectomy performed in a single centre between July 2013-December 2015. Patients data were prospectively collected using Excel 2009 and retrospectively analysed with R v3.2.4 software. Biological status score, surgical severity score and risk scores for complications and death were calculated using: http://www.riskprediction. org.uk/index-pp.php. Results: Morbidity rate was 61,95%: 19,47% general complications, 14,16% wound infections and 28,32% PD specific complications (11,5% POPF; 8,85% DGE and 6,19% PPH). Comparing the observed and estimated morbidity and mortality, we obtained statistical significant results (p=0,05 and p=0,03, respectivelly). When we considered only specific PD complications and subsequent mortality, there was no longer significant difference between observed and estimated values (p=0,8 and p=0,86).The under ROC curve aria was 0,61 for morbidity and 0,64 for specific PD morbidity, respectively 0,61 for mortality and 0,68 for specific PD complications related mortality.

Conclusion: P-POSSUM represents a useful tool for appreciating the complication and death risk after PD, but better results could be obtain by considering also specific PD risk factors.

Keywords: P-POSSUMscore; cephalicpancreaticoduodenectomy; mortality; postoperativemorbidity.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Common Bile Duct Neoplasms / mortality*
  • Common Bile Duct Neoplasms / surgery
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pancreatic Fistula / diagnosis
  • Pancreatic Fistula / etiology*
  • Pancreatic Fistula / mortality*
  • Pancreatic Fistula / surgery
  • Pancreaticoduodenectomy / adverse effects*
  • Pancreaticoduodenectomy / mortality*
  • Predictive Value of Tests
  • Prospective Studies
  • ROC Curve
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Romania / epidemiology
  • Treatment Outcome