Journal Article

Evaluation of POSSUM for Patients Undergoing Pancreatoduodenectomy

Gouma, D. J., de Castro, S. M. M., van Gulik, T. M., Houwert, J. T., Busch, O. R. C., Lagarde, S. M., Reitsma, J. B., Obertop, H.

2009

Overview

Background Comparison of operative morbidity rates after pancreatoduodenectomy between units may be misleading because it does not take into account the physiological variable of the condition of the patients. The aim of the present study was to evaluate the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) for pancreatoduodenectomy patients and to look for risk factors associated with morbidity in a high-volume center. Methods Between January 1993 and April 2006, 652 patients underwent a pancreatoduodenectomy, 502 of them for malignant disease. POSSUM performance was evaluated by assessing the “goodness-of-fit” with the linear analysis method. Results Overall, 332 of the 652 patients (50.9%) had one or more complication after pancreatoduodenectomy, and 9 patients (1.4%) died. POSSUM had a significant lack of fit using goodness-of-fit analysis. In multivariate analysis, one statistically significant factor associated with morbidity and not incorporated in POSSUM ( P  < 0.05) was identified: ampulla of Vater adenocarcinoma (OR = 1.73, 95% CI: 1.07–2.80). Conclusions Overall, there is a lack of calibration of POSSUM among patients who undergo pancreatoduodenectomy.

• Publisher: Springer-Verlag,Springer‐Verlag,Springer,John Wiley & Sons, Inc
• Subject: Abdominal Surgery / Aged / Analysis of Variance / Biological and medical sciences / Cardiac Surgery / Cohort Studies / Confidence Intervals / Disease-Free Survival / Female / General aspects / General Surgery / Humans / International Study Group / Linear Analysis / Linear Models / Male / Medical sciences / Medicine / Medicine & Public Health / Middle Aged / Multivariate Analysis / Neoplasm Invasiveness - pathology / Neoplasm Staging / Netherlands / Odds Ratio / Pancreatic Leakage / Pancreatic Neoplasms - mortality / Pancreatic Neoplasms - pathology / Pancreatic Neoplasms - surgery / Pancreatic Surgery / Pancreaticoduodenectomy - methods / Pancreaticoduodenectomy - mortality / Postoperative Care - methods / Postoperative Complications - mortality / Predictive Value of Tests / Preoperative Care - methods / Probability / Prognosis / Retrospective Studies / Risk Assessment / Severity of Illness Index / Stomach, duodenum, intestine, rectum, anus / Superior Mesenteric Vein / Surgery / Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases / Surgery of the digestive system / Survival Analysis / Thoracic Surgery / Vascular Surgery