Khan Abdaal W, Shah Sudeep R, Agarwal Anil K, Davidson Brian R
University Department of Surgery, Royal Free and University College Medical School, London, UK.
Dig Surg. 2003;20(6):539-45. doi: 10.1159/000073701. Epub 2003 Sep 24.
Wide variations exist in the reported morbidity and mortality rates for major pancreatic resections. The Physiological and Operative Scoring System for enUmeration of Morbidity and mortality (POSSUM) was developed for comparative audit in general surgical patients. It has also been found to be reliable for audit in colorectal, thoracic and vascular surgery with minor modifications.
To evaluate POSSUM and its modification for mortality, P-POSSUM, in pancreatic surgery.
Retrospective analysis of 50 patients undergoing partial pancreaticoduodenectomy (PD) (46 tumours, 4 chronic pancreatitis) using the POSSUM and P-POSSUM as predictors of morbidity and mortality. These were then compared with the observed values.
The POSSUM-predicted mortality was 26%. The P-POSSUM predicted a mortality risk of 6%. The observed mortality was 4%. Using POSSUM for morbidity, the predicted value was 76%. The observed morbidity was 46%. The risk scores for patients with and without morbidity were similar (66.4 +/- 11.0 vs. 68.8 +/- 12.9, p = 0.49).
While P-POSSUM appeared satisfactory for predicting mortality risk, POSSUM overestimated morbidity and mortality for PD in a specialist centre. Modifications are needed prior to its application for comparative audit in pancreatic surgery.
关于大型胰腺切除术的发病率和死亡率报道差异很大。生理和手术评分系统（POSSUM）是为普通外科患者的比较性审计而开发的。经轻微修改后，它在结直肠、胸科和血管外科的审计中也被证明是可靠的。
评估POSSUM及其修改版P-POSSUM在胰腺手术中对死亡率的预测情况。
回顾性分析50例行部分胰十二指肠切除术（PD）的患者（46例肿瘤患者，4例慢性胰腺炎患者），将POSSUM和P-POSSUM作为发病率和死亡率的预测指标，然后与观察值进行比较。
POSSUM预测的死亡率为26%。P-POSSUM预测的死亡风险为6%。观察到的死亡率为4%。使用POSSUM预测发病率，预测值为76%。观察到的发病率为46%。有并发症和无并发症患者的风险评分相似（66.4±11.0对68.8±12.9，p = 0.49）。
虽然P-POSSUM在预测死亡风险方面似乎令人满意，但在专科中心，POSSUM高估了PD的发病率和死亡率。在将其应用于胰腺手术的比较性审计之前，需要进行修改。
