Key result
POSSUM and P-POSSUM scoring systems accurately predicted postoperative mortality (AUC 0.808 and 0.818, respectively), outperforming Cr-POSSUM (AUC 0.693), though all systems tended to overestimate risk.
Why the study?
Do POSSUM, P-POSSUM, and Cr-POSSUM scoring systems accurately predict postoperative morbidity and mortality in elderly colorectal cancer patients?
Observational (n=235)
No
Do POSSUM, P-POSSUM, and Cr-POSSUM scoring systems accurately predict postoperative morbidity and mortality in elderly colorectal cancer patients?
POSSUM and P-POSSUM are more accurate than Cr-POSSUM for predicting postoperative mortality in elderly colorectal cancer patients, although all three systems tend to overestimate risk.
May support preferring POSSUM or P-POSSUM for mortality risk stratification in elderly colorectal cancer surgery; leaves open prospective validation to address overestimation.
The Physiological and Operative Severity Score for the enumeration of Morbidity and Mortality (POSSUM), the Portsmouth-POSSUM (P-POSSUM), and the colorectal-POSSUM (Cr-POSSUM) are relative scoring systems for the prediction of postoperative morbidity and mortality. This study is designed to evaluate the usefulness of each scoring system in elderly colorectal cancer patients undergoing major colorectal surgery. Methods: From January 2000 to May 2008, the authors retrospectively analyzed the medical records of 251 elderly colorectal cancer patients who had undergone surgery. Collected data were analyzed using the Mann-Whitney U-test, a risk stratification analysis, and a receiver-operator characteristic (ROC) curve to evaluate the usefulness and the accuracy of each scoring system. Results: All the predicted morbidity and mortality rates calculated by using the three POSSUM systems were higher than the observed morbidity and mortality rates. A risk stratification analysis showed a considerable correlation in risk prediction between the observed data and the calculated data. The ROC curves showed that all three POSSUM scoring systems had quite high accuracies as predictors of postoperative morbidity and mortality. POSSUM and P-POSSUM were more accurate than Cr-POSSUM. Conclusion: All three scoring systems have a tendency for overestimation. The accuracies of POSSUM, P-POSSUM, and Cr-POSSUM as predictors are acceptance, and POSSUM and P-POSSUM are more accurate than Cr-POSSUM for prediting postoperative morbidity and mortality.
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Sung et al. (2009) conducted an observational in Colorectal cancer (n=235). POSSUM, P-POSSUM, and Cr-POSSUM scoring systems vs. Observed morbidity and mortality was evaluated on Accuracy of predicting postoperative mortality (Area Under the Curve) (AUC 0.818, 95% CI 0.590-1.045, p=0.015). POSSUM and P-POSSUM scoring systems accurately predicted postoperative mortality (AUC 0.808 and 0.818, respectively), outperforming Cr-POSSUM (AUC 0.693), though all systems tended to overestimate risk.
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