Risk adjusted auditing of postop complications in gastric cancer patients by POSSUM

POSSUM (Physiological and Operative Severity Score for the enUmeration of Morbidity and mortality) has been proposed as a promising system for risk adjusted audit in surgical practice. However it has not been generalized in gastric cancer surgery. Present study evaluates the POSSUM on malignant gastric cases in Chinese hospital where patient population or healthcare system might be different than United Kingdom (UK) where the formula was devised. Total of 389 patients who underwent surgical intervention for gastric cancer and malignant gastric lymphomas during the year 2006 were included in the study. Median age was 58 years, with male:female ratio of 7:3. POSSUM data were collected according to standard criteria described by the original authors. Exponential analysis method was used for morbidity predictions. POSSUM predicted satisfactorily for morbidity, observed morbidity was not significantly different than estimated morbidity (p=0.962). Overall, 176 cases were observed to have postoperative complications (including death). The observed to expect ratio (O:E) was 0.99. There was no significant increase in complication rate with increasing age (chi(2)=3.75, 4 d.f, p=0.44). Overall 176 cases were observed to have postop complications (including death). Age was not a risk factor for early postoperative complication. POSSUM predicted well in this study, which means it is a valid system for gastric cancer surgery. However, overall complication rate considered being higher if it is recorded according to POSSUM criteria. Modification in POSSUM equation with revised morbidity definition may be more feasible for major operations.