Invited commentary on 'a systematic review of POSSUM and P-POSSUM as predictors of postoperative morbidity and mortality in patients undergoing pancreatic surgery'

摘要

The systematic review by Wang et al evaluates the usefulness of the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) and especially the Portsmouth POSSUM (P-POSSUM) score in pancreatic surgery. Both scores were introduced in the 1990s with the aim of evaluating the risk of postoperative morbidity and mortality in general surgery, respectively. Because the initial POSSUM score was shown to overestimate mortality, the Portsmouth predictor equation was applied to improve the accuracy of the score; it was primarily established in vascular surgery as the so-called P-POSSUM score. Consequently, both scoring systems were evaluated in different visceral surgical procedures, such as colorectal or esophageal resections. In a considerable number of settings and surgical procedures, these scores showed accurate prediction of morbidity and mortality. However, pancreatic surgery seems to be associated with a risk profile other than that of major gastrointestinal resections, because the authors can show that neither of these scores sufficiently reflects the risk of pancreatic surgery.