Application of Portsmouth modification of physiological and operative severity scoring system for enumeration of morbidity and mortality (P-POSSUM) in pancreatic surgery

World J Surg Oncol. 2008 Apr 9;6:39. doi: 10.1186/1477-7819-6-39.


Background: Pancreatoduodenectomy (PD) is associated with high incidence of morbidity and mortality. We have applied P-POSSUM in predicting the incidence of outcome after PD to identify those who are at the highest risk of developing complications.

Method: A prospective database of 241 consecutive patients who had PD from January 2002 to September 2005 was retrospectively updated and analysed. P-POSSUM score was calculated for each patient and correlated with observed morbidity and mortality.

Results: 30 days mortality was 7.8% and morbidity was 44.8%. Mean physiological score was 16.07 +/- 3.30. Mean operative score was 13.67 +/- 3.42. Mean operative score rose to 20.28 +/- 2.52 for the complex major operation (p < 0.001) with 2 fold increase in morbidity and 3.5 fold increase in mortality. For groups of patients with a physiological score of (less than or equal to) 18, the O:P (observed to Predicted) morbidity ratio was 1.3-1.4 and, with a physiological score of >18, the O:P ratio was nearer to 1. Physiological score and white cell count were significant in a multivariate model.

Conclusion: P-POSSUM underestimated the mortality rate. While P-POSSUM analysis gave a truer prediction of morbidity, underestimation of morbidity and potential for systematic inaccuracy in prediction of complications at lower risk levels is a significant issue for pancreatic surgery.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Databases as Topic
  • Female
  • Health Status Indicators
  • Humans
  • Incidence
  • Male
  • Medical Audit
  • Middle Aged
  • Pancreas / physiopathology
  • Pancreas / surgery*
  • Pancreatic Diseases / mortality
  • Pancreatic Diseases / physiopathology*
  • Pancreatic Diseases / surgery*
  • Pancreatic Neoplasms / surgery
  • Pancreaticoduodenectomy / adverse effects*
  • Pancreaticoduodenectomy / methods
  • Pancreaticoduodenectomy / mortality
  • Prospective Studies
  • Retrospective Studies
  • Severity of Illness Index