Value of PUSSOM and P-POSSUM for the prediction of surgical operative risk in patients undergoing pancreaticoduodenectomy for periampullary tumors
10.3760/cma.j.issn.0253-3766.2015.06.014
- VernacularTitle:计数死亡率和发病率的生理学和手术严重性评分系统及其改进公式版在预测胰十二指肠切除术治疗壶腹周围肿瘤手术风险中的价值
- Author:
Yingtai CHEN
1
;
Yunmian CHU
;
Xu CHE
;
Zhongmin LAN
;
Jianwei ZHANG
;
Chengfeng WANG
Author Information
1. 100021,中国医学科学院 北京协和医学院肿瘤医院腹部外科
- Keywords:
Periampullary neoplasms;
Pancreaticoduodenectomy;
Physlological and operative score for the enumeration of mortality and morbidity,POSSUM;
Complications;
Mortality
- From:
Chinese Journal of Oncology
2015;(6):461-465
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the value of Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity(POSSUM)and a modification of the POSSUM system(P?P0SSUM) scoring system in predicting the surgical operative risk of pancreaticoduodenectomy for periampullary tumors. Methods POSSUM and P?POSSUM scoring systems were used to retrospectively evaluate the clinical data of 432 patients with periampullar tumors who underwent pancreaticoduodenectomy in the Department of Abdominal Surgery, Cancer Hospital,ChineseAcademy of Medical Sciences from January 1985 to December 2010. The predictive occurrence of postoperative complications and mortality rate were calculated according to the formula. ROC curve analysis and different group of risk factors were used to determine the discrimination ability of the two score systems, and to determine their predictive efficacy by comparing the actual and predictive complications and mortality rates, using Hosmer?Lemeshow test to determine the goodness of fit of the two scoring systems. Results The average physiological score of the 432 patients was 16.1±3.5, and the average surgical severity scorewas 19.6±2.7. ROC curve analysis showed that the area under ROC curve for mortality predicted by POSSUM and P?POSSUM were 0.893 and 0.888, showing a non?significant difference ( P>0. 05 ) between them. The area under ROC curve for operative complications predicted by POSSUM scoring system was 0. 575. The POSSUM score system was most accurate for the prediction of complication rates of 20%?40%, showing the O/E value of 0.81. Compared with the POSSUM score system, P?POSSUM had better ability in the prediction of postoperative mortality, when the predicted value of mortality was greater than 15%, the predictive result was more accurate, and the O/E value was 1.00. Conclusions POSSUM and P?POSSUM scoring system have good value in predicting the mortality of patients with periampullary tumors undergoing pancreaticoduodenectomy, but a poorer value of POSSUM score system in prediction of complications. We can establish a more suitable scoring system for pancreaticoduodenectomy by modifying the score constant and weight, to better predict surgical risk and reduce the operative complications and mortality.
