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POSSUM scoring for laparoscopic cholecystectomy in the elderly
Andrew L Tambyraja1, Sudhir Kumar, Stephen J Nixon
1Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK. andrew.tambyraja@ed.ac.uk
ANZ Journal of Surgery
|June 24, 2005
Summary
Physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) scoring accurately predicts morbidity but overestimates mortality in elderly patients undergoing laparoscopic cholecystectomy. Further evaluation for other laparoscopic procedures is recommended.
Area of Science:
- Surgical Outcomes Research
- Geriatric Surgery
- Health Services Research
Background:
- The Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) is a validated tool for auditing surgical outcomes.
- Existing POSSUM evaluations primarily focus on open surgical techniques.
- The study investigates POSSUM's applicability to laparoscopic cholecystectomy (LC) in elderly patients.
Purpose of the Study:
- To assess the accuracy of POSSUM scoring in predicting morbidity and mortality following laparoscopic cholecystectomy (LC) in patients aged 80 years and above.
- To evaluate the performance of POSSUM in a specific high-risk surgical population.
Main Methods:
- A retrospective review of 70 patients aged 80+ who underwent LC between 1993 and 1999.
- Data collection included clinical and operative factors for POSSUM scoring.
- Calculation of Observed/POSSUM estimated (O/E) ratios for morbidity and 30-day mortality.
Main Results:
- Laparoscopic cholecystectomy was performed on 76 elderly patients; 70 case notes were reviewed.
- Fifteen patients (22%) experienced significant postoperative morbidity, with no 30-day mortality.
- POSSUM predicted 15 cases of morbidity (O/E ratio 1) and 7 deaths (O/E ratio 0).
Conclusions:
- POSSUM scoring demonstrates good performance in predicting morbidity after LC in octogenarians.
- POSSUM tends to overpredict mortality in this patient group.
- Further research is warranted to assess POSSUM's utility in other laparoscopic procedures.