POSSUM and P-POSSUM as Predictors of Postoperative Morbidity and Mortality in Patients Undergoing Hepatobiliary Surgery: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 WANGHao-lu ^1,2 , WANGhui ¹ , CHENTao ¹ , CHENWei ¹ , SONGYan-yan ³ ,  WANGJian ¹

1. Department of Biliary-pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China;
2. Therapeutics Research Centre, Princess Alexandra Hospital, School of Medicine, The University of Queensland, Woolloongabba, QLD 4102, Australia;
3. Department of Biostatistics, Institutes of Medical Sciences, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China;

Corresponding author：

WANGJian, Email: dr_wangjian@126.com

Keywords：

POSSUM; P-POSSUM; Hepatobiliary surgery; Surgical risk scoring system; Systematic review; Metaanalysis

DOI：

10.7507/1672-2531.20140077

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Objective The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) model and its Portsmouth (P-POSSUM) modification are used extensively to predict post-operative mortality and morbidity in general surgery. The aim was to analysis the predictive value of these models in patients undergoing hepatobiliary surgery. Methods Eligible articles were identified by searching such electronic databases as PubMed, The Cochrane Library (Issue 10, 2013), Science Citation Index, CNKI, WanFang Data and CBM from 1991 to October 2013. Each study was assessed according to the inclusion and exclusion criteria. Then data were extracted, pooled, and analyzed using Comprehensive Meta Analysis Version 2. Results Ten studies were included. The morbidity analysis included five studies and 683 patients on POSSUM with a weighted O/E ratio 0.71 (95%CI 0.60 to 0.81). The mortality analysis included seven studies with 1 291 patients on POSSUM and six studies with 1 793 patients on P-POSSUM. Weighted O/E ratios for mortality were 0.42 (95%CI 0.27 to 0.57) for POSSUM and 0.74 (95%CI 0.53 to 0.95) for P-POSSUM. Conclusion POSSUM significantly overestimates postoperative morbidity in patients undergoing hepatobiliary surgery. Compared with the original POSSUM, P-POSSUM is more accurate for predicting post-operative mortality. Modifications to POSSUM and P-POSSUM are needed for audit in hepatobiliary surgery.

Citation： WANGHao-lu, WANGhui, CHENTao, CHENWei, SONGYan-yan, WANGJian. POSSUM and P-POSSUM as Predictors of Postoperative Morbidity and Mortality in Patients Undergoing Hepatobiliary Surgery: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(4): 443-448. doi: 10.7507/1672-2531.20140077 Copy

1.	Povoski SP, Downey RJ, Dudrick PS, et al.The critically ill patient after hepatobiliary surgery.Crit Care, 1999, 3(6):139-144.
2.	Copeland GP, Jones D, Walters M.POSSUM:a scoring system for surgical audit.Br J Surg, 1991, 78(3):355-360.
3.	Whiteley MS, Prytherch DR, Higgins B, et al.An evaluation of the POSSUM surgical scoring system.Br J Surg, 1996, 83(6):812-815.
4.	Richards CH, Leitch FE, Horgan PG, et al.A systematic review of POSSUM and its related models as predictors of post-operative mortality and morbidity in patients undergoing surgery for colorectal cancer.J Gastrointest Surg, 2010, 14(10):1511-1520.
5.	Dutta S, Horgan PG, McMillan DC.POSSUM and its related models as predictors of postoperative mortality and morbidity in patients undergoing surgery for gastro-oesophageal cancer:a systematic review.World J Surg, 2010, 34(9):2076-2082.
6.	Wang H, Chen T, Wang H, et al.A systematic review of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity and its Portsmouth modification as predictors of post-operative morbidity and mortality in patients undergoing pancreatic surgery.Am J Surg, 2013, 205(4):466-472.
7.	Oxford Centre for Evidence-based Medicine.Levels of evidence, 2009 Mar.Available at:http://www.cebm.net/index.aspx?o=1025.
8.	Kocher HM, Tekkis PP, Gopal P, et al.Risk-adjustment in hepatobiliary pancreatic surgery.World J Gastroenterol, 2005, 11(16):2450-2455.
9.	Haga Y, Ikejiri K, Takeuchi H, et al.Value of general surgical risk models for predicting postoperative liver failure and mortality following liver surgery.J Surg Oncol, 2012, 106(7):898-904.
10.	Vij V, Soin AS, Gupta S, et al.POSSUM as a predictor of mortality in liver resections.J Gastroenterol Hepatol, 2004, 19(S):A844.
11.	Thomas RL, Madani R, Worthington TR, et al.The usefulness of PPOSSUM score in patients undergoing elective liver resection for benign disease, metastatic colorectal cancer and non-colorectal cancer.Br J Surg, 2011, 98(S3):44.
12.	Markus PM, Martell J, Leister I, et al.Predicting postoperative morbidity by clinical assessment.Br J Surg, 2005, 92(1):101-106.
13.	Hellmann S, Schafmayer C, Hinz S, et al.Evaluation of the POSSUM score in surgical treatment of cholangiocarcinoma.Hepatogastroenterology, 2010, 57(5-6):403-408.
14.	陈秀凯, 秦建民, 李文雄, 等.POSSUM评分系统在肝移植中作用及临床意义.中华肝胆外科杂志, 2009, 15(2):87-89.
15.	熊俊, 尚丹.计数死亡率和发病率的生理学和手术严重性评分系统在肝切除术中的临床应用价值.中国现代医学杂志, 2009, 19(4):564-569.
16.	Lam CM, Fan ST, Yuen AW, et al.Validation of POSSUM scoring systems for audit of major hepatectomy.Br J Surg, 2004, 91(4):450-454.
17.	Neal CP, Pattenden CJ, Mann CD, et al.Validation of the POSSUM and P-POSSUM scoring systems for audit of mortality following hepatectomy for benign and malignant disease.HPB (Oxford), 2006, 8:174.
18.	刘夕水, 苏东玮, 施俊义, 等.POSSUM、P-POSSUM和APACHE-Ⅱ评分对肝门部胆管癌手术后住院死亡风险评估的对比研究.现代生物医学进展, 2011, 11(8):35-37.
19.	李珂, 薛焕洲, 王亚东, 等.P-POSSUM评分系统预测60岁以上肝癌患者手术风险的价值.中国普通外科杂志, 2011, 20(7):691-695.
20.	张志强, 蔡兵, 吴鸣宇, 等.POSSUM和P-POSSUM评分系统对肝部分切除手术风险度的评估.中国现代医药杂志, 2010, 12(12):45-47.
21.	Pratt W, Joseph S, Callery MP, et al.POSSUM accurately predicts morbidity for pancreatic resection.Surgery, 2008, 143(1):8-19.

1. Povoski SP, Downey RJ, Dudrick PS, et al.The critically ill patient after hepatobiliary surgery.Crit Care, 1999, 3(6):139-144.
2. Copeland GP, Jones D, Walters M.POSSUM:a scoring system for surgical audit.Br J Surg, 1991, 78(3):355-360.
3. Whiteley MS, Prytherch DR, Higgins B, et al.An evaluation of the POSSUM surgical scoring system.Br J Surg, 1996, 83(6):812-815.
4. Richards CH, Leitch FE, Horgan PG, et al.A systematic review of POSSUM and its related models as predictors of post-operative mortality and morbidity in patients undergoing surgery for colorectal cancer.J Gastrointest Surg, 2010, 14(10):1511-1520.
5. Dutta S, Horgan PG, McMillan DC.POSSUM and its related models as predictors of postoperative mortality and morbidity in patients undergoing surgery for gastro-oesophageal cancer:a systematic review.World J Surg, 2010, 34(9):2076-2082.
6. Wang H, Chen T, Wang H, et al.A systematic review of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity and its Portsmouth modification as predictors of post-operative morbidity and mortality in patients undergoing pancreatic surgery.Am J Surg, 2013, 205(4):466-472.
7. Oxford Centre for Evidence-based Medicine.Levels of evidence, 2009 Mar.Available at:http://www.cebm.net/index.aspx?o=1025.
8. Kocher HM, Tekkis PP, Gopal P, et al.Risk-adjustment in hepatobiliary pancreatic surgery.World J Gastroenterol, 2005, 11(16):2450-2455.
9. Haga Y, Ikejiri K, Takeuchi H, et al.Value of general surgical risk models for predicting postoperative liver failure and mortality following liver surgery.J Surg Oncol, 2012, 106(7):898-904.
10. Vij V, Soin AS, Gupta S, et al.POSSUM as a predictor of mortality in liver resections.J Gastroenterol Hepatol, 2004, 19(S):A844.
11. Thomas RL, Madani R, Worthington TR, et al.The usefulness of PPOSSUM score in patients undergoing elective liver resection for benign disease, metastatic colorectal cancer and non-colorectal cancer.Br J Surg, 2011, 98(S3):44.
12. Markus PM, Martell J, Leister I, et al.Predicting postoperative morbidity by clinical assessment.Br J Surg, 2005, 92(1):101-106.
13. Hellmann S, Schafmayer C, Hinz S, et al.Evaluation of the POSSUM score in surgical treatment of cholangiocarcinoma.Hepatogastroenterology, 2010, 57(5-6):403-408.
14. 陈秀凯, 秦建民, 李文雄, 等.POSSUM评分系统在肝移植中作用及临床意义.中华肝胆外科杂志, 2009, 15(2):87-89.
15. 熊俊, 尚丹.计数死亡率和发病率的生理学和手术严重性评分系统在肝切除术中的临床应用价值.中国现代医学杂志, 2009, 19(4):564-569.
16. Lam CM, Fan ST, Yuen AW, et al.Validation of POSSUM scoring systems for audit of major hepatectomy.Br J Surg, 2004, 91(4):450-454.
17. Neal CP, Pattenden CJ, Mann CD, et al.Validation of the POSSUM and P-POSSUM scoring systems for audit of mortality following hepatectomy for benign and malignant disease.HPB (Oxford), 2006, 8:174.
18. 刘夕水, 苏东玮, 施俊义, 等.POSSUM、P-POSSUM和APACHE-Ⅱ评分对肝门部胆管癌手术后住院死亡风险评估的对比研究.现代生物医学进展, 2011, 11(8):35-37.
19. 李珂, 薛焕洲, 王亚东, 等.P-POSSUM评分系统预测60岁以上肝癌患者手术风险的价值.中国普通外科杂志, 2011, 20(7):691-695.
20. 张志强, 蔡兵, 吴鸣宇, 等.POSSUM和P-POSSUM评分系统对肝部分切除手术风险度的评估.中国现代医药杂志, 2010, 12(12):45-47.
21. Pratt W, Joseph S, Callery MP, et al.POSSUM accurately predicts morbidity for pancreatic resection.Surgery, 2008, 143(1):8-19.

Chinese Journal of Evidence-Based Medicine

POSSUM and P-POSSUM as Predictors of Postoperative Morbidity and Mortality in Patients Undergoing Hepatobiliary Surgery: A Meta-Analysis

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