POSSUM, P-POSSUM, and CR-POSSUM scoring systems significantly overpredicted postoperative morbidity and in-hospital mortality in patients undergoing colorectal surgery.
Cohort
Do POSSUM, P-POSSUM, and CR-POSSUM scoring systems accurately predict postoperative complications and mortality in patients undergoing colorectal surgery?
The POSSUM, P-POSSUM, and CR-POSSUM scoring systems are too imprecise for estimating perioperative complications and mortality in modern colorectal surgery and require revision.
BACKGROUND: The Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) weights the patient's individual health status and the extent of the surgical procedure to estimate the probability of postoperative complications and death of general surgery patients. The variations Portsmouth-POSSUM (P-POSSUM) and colorectal POSSUM (CR-POSSUM) were developed for estimating mortality in patients with low perioperative risk and for patients with colorectal carcinoma, respectively. The aim of the present study was to evaluate the significance of POSSUM, P-POSSUM, and CR-POSSUM in two independent colorectal cancer cohorts undergoing surgery, with an emphasis on laparoscopic procedures. METHODS: For each patient, an individual physiological score (PS) and operative severity score (OS) was attributed to calculate the predicted morbidity and mortality, respectively. Logistic regression analysis was used to evaluate the possible correlation between the subscores and the probability of postoperative complications and mortality. RESULTS: The POSSUM equation significantly overpredicted postoperative morbidity, and all three scoring systems considerably overpredicted in-hospital mortality. However, the POSSUM score identified patients at risk of anastomotic leakage, sepsis, and the need for reoperation. Logistic regression analysis demonstrated a strong correlation between the subscores and the probability of postoperative complications and mortality, respectively. CONCLUSION: Our results suggest that the three scoring systems are too imprecise for the estimation of perioperative complications and mortality of patients undergoing colorectal surgery in the present day. Since the subscores proved valid, a revision of the scoring systems could increase their reliability in the clinical setting.
Bürtin et al. (2023) conducted a cohort in Colorectal cancer. POSSUM, P-POSSUM, and CR-POSSUM scoring systems was evaluated on Postoperative complications and in-hospital mortality. POSSUM, P-POSSUM, and CR-POSSUM scoring systems significantly overpredicted postoperative morbidity and in-hospital mortality in patients undergoing colorectal surgery.
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