Key result
P-POSSUM accurately predicts abdominal surgery mortality, whereas POSSUM overestimates morbidity and mortality.
Why the study?
Different predictive tools exist to quantify perioperative morbidity and mortality risk in high-risk abdominal surgery, but the accuracy of POSSUM versus P-POSSUM remains uncertain.
Does the P-POSSUM score predict perioperative mortality more accurately than the POSSUM score in patients undergoing abdominal surgery?
Observational (n=350)
No
Does the P-POSSUM score predict perioperative mortality more accurately than the POSSUM score in patients undergoing abdominal surgery?
Effect estimate: Pearson coefficient 0.948
p-value: p=<0.001
P-POSSUM is a more accurate predictor of mortality risk than POSSUM in patients undergoing abdominal surgery, as POSSUM tends to overestimate risk.
Supports selective P-POSSUM use for mortality risk assessment in abdominal surgery; leaves open prospective validation against alternatives.
BACKGROUND: High-risk surgical procedures represent a fundamental part of general surgery practice due to its significant rates of morbidity and mortality. Different predictive tools have been created in order to quantify perioperative morbidity and mortality risk. POSSUM (Physiological and Operative Severity Score for the enumeration of Mortality and morbidity) is one of the most widely validated predictive scores considering physiological and operative variables to precisely define morbimortality risk. Nevertheless, seeking greater accuracy in predictions P-POSSUM was proposed. We aimed to compare POSSUM and P-POSSUM for patients undergoing abdominal surgery. METHODS: A retrospective observational study with a prospective database was conducted. Patients over 18 years old who complied with inclusion criteria between 2015 and 2016 were included. Variables included in the POSSUM and P-POSSUM Scores were analyzed. Descriptive statistics of all study parameters were provided. The analysis included socio-demographic data, laboratory values , and imaging. Bivariate analysis was performed. RESULTS: 350 Patients were included in the analysis, 55.1% were female. The mean age was 55.9 ± 20.4 years old. POSSUM revealed a moderated index score in 61.7% of the patients, mean score of 12.85 points ± 5.61. 89.1% of patients had no neoplastic diagnosis associated. Overall morbidity and mortality rate was 14.2% and 7.1%. P-POSSUM could predict more precisely mortality (p < 0.00). CONCLUSIONS: The POSSUM score is likely to overestimate the risk of morbidity and mortality in patients with high/moderate risk, while the P-POSSUM score seems to be a more accurate predictor of mortality risk. Further studies are needed to confirm our results.
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Valenzuela et al. (2022) conducted an observational in Abdominal surgery (n=350). P-POSSUM score vs. POSSUM score was evaluated on Mortality prediction (correlation with observed mortality) (Pearson coefficient 0.948, p=<0.001). The P-POSSUM score accurately predicted mortality in patients undergoing abdominal surgery with a strong statistical correlation (Pearson coefficient 0.948, p<0.001), whereas the POSSUM score overestimated both morbidity and mortality.
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