gms | German Medical Science

Introduction: The Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) is a predictive scoring system for postoperative morbidity. While numerous studies validate its application to major abdominal surgery, few exclusively consider pancreatic resections, whose unique complications are costly and problematic. We examined whether POSSUM could accurately reflect clinical outcomes in pancreatic resection.

Material and methods: 697 consecutive pancreatic head resections (446 classic Whipples, 251 PPPD) were performed between 1993 and 2010 in the Department of General, Thoracic and Vascular Surgery, University Hospital Dresden. POSSUM score was calculated for each case, and compared to observed morbidity. Binary logistic regression was used to make further statements about the validity of the score.

Results: The POSSUM-predicted morbidity was 50.5%. The observed morbidity was 43.6%. The Hosmer-Lemeshow goodness-of-fit test validated POSSUM as a predictive scoring system for postoperative morbidity. However, the model had a significant poor fit. Therefore we adapted the score and complemented it with additional prognostic parameters. The new "German" Possum-score was tested in a patient cohort from two other German high volume centres and showed a better prognostic value.

Conclusion: POSSUM was statistically shown to be a valid perioperative scoring system for pancreatic surgical outcomes. However, the score showed poor fit. Maybe the adapted score demonstrated in our study might be of better use for the predicition of morbidity in pancreatic surgery.