Physiologic and operative severity score for the enUmeration of mortality and morbidity (POSSUM) is a predictive scoring system for postoperative morbidity.
While numerous studies validate its application to major abdominal surgery, few exclusively consider pancreatic resections, whose unique complications are costly and problematic.
|Increasing morbidity risk was associated with longer hospital stays|
Dr Wande Pratt and colleagues from Boston, USA examined whether physiologic and operative severity score for mortality and morbidity could accurately reflect clinical and economic outcomes in pancreatic resection.
The team performed 326 consecutive pancreatic resections between 2001 and 2007.
Physiologic and operative severity score for mortality and morbidity was prospectively calculated for each case, and patients were stratified to quintiles of morbidity risk.
The team compared actual clinical and economic outcomes across the groups.
Predictive risk assessment was further evaluated independently within each resection type.
Logistic regression analysis was performed to identify specific POSSUM scores for mortality and morbidity parameters predictive of postoperative morbidity.
The researchers observed that expected morbidity rates were equivalent for either method.
Clinical, and economic outcomes progressively worsened with escalations in POSSUM scores for mortality and morbidity.
The researchers found that increasing morbidity risk was associated with significantly longer hospital stays.
Higher rates of complications, and more blood transfusions, intensive care unit management, and discharge to rehabilitation facilities were also associated with increased morbidity risk.
The team of researchers found this had considerable economic impact, as mean hospital costs rose from $19,951 in the 20% to 40% risk cohort, to $31,281 in the 80% risk cohort.
Breakdown by operation type demonstrates that the POSSUM score for mortality and morbidity definitively predicts morbidity following both proximal and distal resection.
However, it more accurately forecasts the need for intensive care unit management and rehabilitation placement when pancreatoduodenectomy is performed.
Multivariate analysis revealed that half of the POSSUM score for mortality and morbidity parameters were significant contributors for postoperative morbidity.
The team noted that age, preoperative hemoglobin concentration, and intraoperative blood loss demonstrated the strongest correlations.
Dr Pratt's team concluded, "Physiologic and operative severity score enUmeration for mortality and morbidity is a valuable perioperative scoring system for evaluating variance in pancreatic surgical methods, and outcomes."
"This score can also be employed to guide management decisions that impact postoperative recovery."