This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Validation of POSSUM scoring systems for audit of major hepatectomy. BJS 2004; 91: 450-454.
Published: 20th February 2004
Authors: C.‐M. Lam, S.‐T. Fan, A. W.‐C. Yuen, W.‐L. Law, K. Poon
Background
The aim of the study was to validate the use of Physiological and Operative Severity Score in the enUmeration of Mortality and morbidity (POSSUM) and Portsmouth (P) POSSUM scoring systems to predict postoperative mortality in a group of Chinese patients who had a major hepatectomy for hepatocellular carcinoma.
Method
A retrospective analysis was performed on data collected prospectively over a 6‐year interval from January 1997 to December 2002. The mortality risks were calculated using both the POSSUM and the P‐POSSUM equations.
Results
Two hundred and fifty‐nine patients underwent major hepatectomy; there were 17 (6·6 per cent) postoperative deaths. Of 32 preoperative and intraoperative variables studied, age, smoking habit, serum creatinine concentration, American Society of Anesthesiologists grade, and physiological and operative severity scores were found to be significant factors predicting mortality. On multivariate analysis only the physiological and operative severity scores were independent variables. The POSSUM system overpredicted mortality risk (14·2 per cent) and there was a significant lack of fit in these patients (χ2 = 14·1, 3 d.f., P = 0·003). The mortality rate predicted by P‐POSSUM was 4·2 per cent and showed no significant lack of fit (χ2 = 7·6, 3 d.f., P = 0·055), indicating that it predicted outcome effectively. A new logistic equation was derived from the present patient data set that requires testing prospectively.
Conclusion
P‐POSSUM significantly predicted outcome in Chinese patients who had major hepatectomy for hepatocellular carcinoma. A modified disease‐specific equation requires further testing. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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