POSSUM accurately predicts morbidity for pancreatic resection

Area of Science:

• Surgical Oncology
• Predictive Analytics in Medicine
• Health Economics

Background:

• The Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) is a validated tool for predicting postoperative morbidity in general abdominal surgery.
• Its specific application and accuracy in pancreatic resections, which have unique and costly complications, remain less understood.
• This study aimed to assess the utility of POSSUM in predicting clinical and economic outcomes following pancreatic resections.

Purpose of the Study:

• To evaluate the accuracy of the POSSUM score in predicting postoperative morbidity and mortality in patients undergoing pancreatic resections.
• To correlate POSSUM-assigned risk quintiles with actual clinical outcomes, including hospital stay, complication rates, and resource utilization.
• To assess the economic impact of POSSUM-predicted risk on hospital costs associated with pancreatic surgery.

Main Methods:

• A prospective analysis of 326 consecutive pancreatic resections (including pancreaticoduodenectomies, distal, central, and total pancreatectomies) was conducted.
• POSSUM scores were calculated for each patient, and they were stratified into five morbidity risk quintiles (< or = 20% to > or = 80%).
• Clinical outcomes (morbidity, hospital stay, complications, ICU use, rehabilitation) and economic outcomes (hospital costs) were compared across risk groups. Logistic regression identified predictive POSSUM parameters.

Main Results:

• Observed and expected morbidity rates were comparable (53.1% vs 55.5%, O/E ratio 0.96).
• Clinical and economic outcomes significantly worsened with increasing POSSUM risk scores, including longer hospital stays, higher complication rates, and increased costs (e.g., $19,951 to $31,281).
• POSSUM accurately predicted morbidity for proximal and distal resections, particularly forecasting ICU needs and rehabilitation post-pancreaticoduodenectomy. Age, hemoglobin, and blood loss were key predictors.

Conclusions:

• The POSSUM scoring system is a valuable tool for assessing perioperative risk in pancreatic surgery.
• It accurately reflects clinical outcomes and associated economic burdens, aiding in the management of patients undergoing pancreatic resections.
• POSSUM can guide clinical decisions to optimize postoperative recovery and resource allocation.