POSSUM and P-POSSUM as Predictors of Postoperative Morbidity and Mortality in Patients Undergoing Hepatobiliary Surgery: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 WANGHao-lu ^1,2 , WANGhui ¹ , CHENTao ¹ , CHENWei ¹ , SONGYan-yan ³ ,  WANGJian ¹

1. Department of Biliary-pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China;
2. Therapeutics Research Centre, Princess Alexandra Hospital, School of Medicine, The University of Queensland, Woolloongabba, QLD 4102, Australia;
3. Department of Biostatistics, Institutes of Medical Sciences, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China;

Corresponding?author：

WANGJian, Email: dr_wangjian@126.com

Keywords：

POSSUM; P-POSSUM; Hepatobiliary surgery; Surgical risk scoring system; Systematic review; Metaanalysis

DOI：

10.7507/1672-2531.20140077

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Objective The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) model and its Portsmouth (P-POSSUM) modification are used extensively to predict post-operative mortality and morbidity in general surgery. The aim was to analysis the predictive value of these models in patients undergoing hepatobiliary surgery. Methods Eligible articles were identified by searching such electronic databases as PubMed, The Cochrane Library (Issue 10, 2013), Science Citation Index, CNKI, WanFang Data and CBM from 1991 to October 2013. Each study was assessed according to the inclusion and exclusion criteria. Then data were extracted, pooled, and analyzed using Comprehensive Meta Analysis Version 2. Results Ten studies were included. The morbidity analysis included five studies and 683 patients on POSSUM with a weighted O/E ratio 0.71 (95%CI 0.60 to 0.81). The mortality analysis included seven studies with 1 291 patients on POSSUM and six studies with 1 793 patients on P-POSSUM. Weighted O/E ratios for mortality were 0.42 (95%CI 0.27 to 0.57) for POSSUM and 0.74 (95%CI 0.53 to 0.95) for P-POSSUM. Conclusion POSSUM significantly overestimates postoperative morbidity in patients undergoing hepatobiliary surgery. Compared with the original POSSUM, P-POSSUM is more accurate for predicting post-operative mortality. Modifications to POSSUM and P-POSSUM are needed for audit in hepatobiliary surgery.

Citation： WANGHao-lu, WANGhui, CHENTao, CHENWei, SONGYan-yan, WANGJian. POSSUM and P-POSSUM as Predictors of Postoperative Morbidity and Mortality in Patients Undergoing Hepatobiliary Surgery: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(4): 443-448. doi: 10.7507/1672-2531.20140077 Copy

1.	Povoski SP, Downey RJ, Dudrick PS, et al.The critically ill patient after hepatobiliary surgery.Crit Care, 1999, 3(6):139-144.
2.	Copeland GP, Jones D, Walters M.POSSUM:a scoring system for surgical audit.Br J Surg, 1991, 78(3):355-360.
3.	Whiteley MS, Prytherch DR, Higgins B, et al.An evaluation of the POSSUM surgical scoring system.Br J Surg, 1996, 83(6):812-815.
4.	Richards CH, Leitch FE, Horgan PG, et al.A systematic review of POSSUM and its related models as predictors of post-operative mortality and morbidity in patients undergoing surgery for colorectal cancer.J Gastrointest Surg, 2010, 14(10):1511-1520.
5.	Dutta S, Horgan PG, McMillan DC.POSSUM and its related models as predictors of postoperative mortality and morbidity in patients undergoing surgery for gastro-oesophageal cancer:a systematic review.World J Surg, 2010, 34(9):2076-2082.
6.	Wang H, Chen T, Wang H, et al.A systematic review of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity and its Portsmouth modification as predictors of post-operative morbidity and mortality in patients undergoing pancreatic surgery.Am J Surg, 2013, 205(4):466-472.
7.	Oxford Centre for Evidence-based Medicine.Levels of evidence, 2009 Mar.Available at:http://www.cebm.net/index.aspx?o=1025.
8.	Kocher HM, Tekkis PP, Gopal P, et al.Risk-adjustment in hepatobiliary pancreatic surgery.World J Gastroenterol, 2005, 11(16):2450-2455.
9.	Haga Y, Ikejiri K, Takeuchi H, et al.Value of general surgical risk models for predicting postoperative liver failure and mortality following liver surgery.J Surg Oncol, 2012, 106(7):898-904.
10.	Vij V, Soin AS, Gupta S, et al.POSSUM as a predictor of mortality in liver resections.J Gastroenterol Hepatol, 2004, 19(S):A844.
11.	Thomas RL, Madani R, Worthington TR, et al.The usefulness of PPOSSUM score in patients undergoing elective liver resection for benign disease, metastatic colorectal cancer and non-colorectal cancer.Br J Surg, 2011, 98(S3):44.
12.	Markus PM, Martell J, Leister I, et al.Predicting postoperative morbidity by clinical assessment.Br J Surg, 2005, 92(1):101-106.
13.	Hellmann S, Schafmayer C, Hinz S, et al.Evaluation of the POSSUM score in surgical treatment of cholangiocarcinoma.Hepatogastroenterology, 2010, 57(5-6):403-408.
14.	陳秀凱, 秦建民, 李文雄, 等.POSSUM評分系統在肝移植中作用及臨床意義.中華肝膽外科雜志, 2009, 15(2):87-89.
15.	熊俊, 尚丹.計數死亡率和發病率的生理學和手術嚴重性評分系統在肝切除術中的臨床應用價值.中國現代醫學雜志, 2009, 19(4):564-569.
16.	Lam CM, Fan ST, Yuen AW, et al.Validation of POSSUM scoring systems for audit of major hepatectomy.Br J Surg, 2004, 91(4):450-454.
17.	Neal CP, Pattenden CJ, Mann CD, et al.Validation of the POSSUM and P-POSSUM scoring systems for audit of mortality following hepatectomy for benign and malignant disease.HPB (Oxford), 2006, 8:174.
18.	劉夕水, 蘇東瑋, 施俊義, 等.POSSUM、P-POSSUM和APACHE-Ⅱ評分對肝門部膽管癌手術后住院死亡風險評估的對比研究.現代生物醫學進展, 2011, 11(8):35-37.
19.	李珂, 薛煥洲, 王亞東, 等.P-POSSUM評分系統預測60歲以上肝癌患者手術風險的價值.中國普通外科雜志, 2011, 20(7):691-695.
20.	張志強, 蔡兵, 吳鳴宇, 等.POSSUM和P-POSSUM評分系統對肝部分切除手術風險度的評估.中國現代醫藥雜志, 2010, 12(12):45-47.
21.	Pratt W, Joseph S, Callery MP, et al.POSSUM accurately predicts morbidity for pancreatic resection.Surgery, 2008, 143(1):8-19.

1. Povoski SP, Downey RJ, Dudrick PS, et al.The critically ill patient after hepatobiliary surgery.Crit Care, 1999, 3(6):139-144.
2. Copeland GP, Jones D, Walters M.POSSUM:a scoring system for surgical audit.Br J Surg, 1991, 78(3):355-360.
3. Whiteley MS, Prytherch DR, Higgins B, et al.An evaluation of the POSSUM surgical scoring system.Br J Surg, 1996, 83(6):812-815.
4. Richards CH, Leitch FE, Horgan PG, et al.A systematic review of POSSUM and its related models as predictors of post-operative mortality and morbidity in patients undergoing surgery for colorectal cancer.J Gastrointest Surg, 2010, 14(10):1511-1520.
5. Dutta S, Horgan PG, McMillan DC.POSSUM and its related models as predictors of postoperative mortality and morbidity in patients undergoing surgery for gastro-oesophageal cancer:a systematic review.World J Surg, 2010, 34(9):2076-2082.
6. Wang H, Chen T, Wang H, et al.A systematic review of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity and its Portsmouth modification as predictors of post-operative morbidity and mortality in patients undergoing pancreatic surgery.Am J Surg, 2013, 205(4):466-472.
7. Oxford Centre for Evidence-based Medicine.Levels of evidence, 2009 Mar.Available at:http://www.cebm.net/index.aspx?o=1025.
8. Kocher HM, Tekkis PP, Gopal P, et al.Risk-adjustment in hepatobiliary pancreatic surgery.World J Gastroenterol, 2005, 11(16):2450-2455.
9. Haga Y, Ikejiri K, Takeuchi H, et al.Value of general surgical risk models for predicting postoperative liver failure and mortality following liver surgery.J Surg Oncol, 2012, 106(7):898-904.
10. Vij V, Soin AS, Gupta S, et al.POSSUM as a predictor of mortality in liver resections.J Gastroenterol Hepatol, 2004, 19(S):A844.
11. Thomas RL, Madani R, Worthington TR, et al.The usefulness of PPOSSUM score in patients undergoing elective liver resection for benign disease, metastatic colorectal cancer and non-colorectal cancer.Br J Surg, 2011, 98(S3):44.
12. Markus PM, Martell J, Leister I, et al.Predicting postoperative morbidity by clinical assessment.Br J Surg, 2005, 92(1):101-106.
13. Hellmann S, Schafmayer C, Hinz S, et al.Evaluation of the POSSUM score in surgical treatment of cholangiocarcinoma.Hepatogastroenterology, 2010, 57(5-6):403-408.
14. 陳秀凱, 秦建民, 李文雄, 等.POSSUM評分系統在肝移植中作用及臨床意義.中華肝膽外科雜志, 2009, 15(2):87-89.
15. 熊俊, 尚丹.計數死亡率和發病率的生理學和手術嚴重性評分系統在肝切除術中的臨床應用價值.中國現代醫學雜志, 2009, 19(4):564-569.
16. Lam CM, Fan ST, Yuen AW, et al.Validation of POSSUM scoring systems for audit of major hepatectomy.Br J Surg, 2004, 91(4):450-454.
17. Neal CP, Pattenden CJ, Mann CD, et al.Validation of the POSSUM and P-POSSUM scoring systems for audit of mortality following hepatectomy for benign and malignant disease.HPB (Oxford), 2006, 8:174.
18. 劉夕水, 蘇東瑋, 施俊義, 等.POSSUM、P-POSSUM和APACHE-Ⅱ評分對肝門部膽管癌手術后住院死亡風險評估的對比研究.現代生物醫學進展, 2011, 11(8):35-37.
19. 李珂, 薛煥洲, 王亞東, 等.P-POSSUM評分系統預測60歲以上肝癌患者手術風險的價值.中國普通外科雜志, 2011, 20(7):691-695.
20. 張志強, 蔡兵, 吳鳴宇, 等.POSSUM和P-POSSUM評分系統對肝部分切除手術風險度的評估.中國現代醫藥雜志, 2010, 12(12):45-47.
21. Pratt W, Joseph S, Callery MP, et al.POSSUM accurately predicts morbidity for pancreatic resection.Surgery, 2008, 143(1):8-19.

Chinese Journal of Evidence-Based Medicine

POSSUM and P-POSSUM as Predictors of Postoperative Morbidity and Mortality in Patients Undergoing Hepatobiliary Surgery: A Meta-Analysis

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