POSSUM and P-POSSUM skiring assessment in prediction of postoperative complications and mortality in mechanical jaundice

Magomedov M., Khamidov M., Magomedov Kh.

Purpose. Evaluation of the feasibility of using POSSUM and P-POSSUM as a risk assessment system as a tool for effectively predicting mortality and morbidity from obstructive jaundice. Material and methods. A randomized prospective study of 179 patients over the age of 50 (mean age 58.9 ± 10.4 years) with obstructive jaundice was carried out. Among the patients there were 75 (41.9%) men and 104 (58.1%) women. The following diseases were diagnosed: gastrointestinal tract complicated by obstructive jaundice (n = 128); papillostenosis complicated by obstructive jaundice (n = 21); postcholecystectomy syndrome of complicated breast (n = 10); choledocholithiasis in combination with papillomastenosis (n = 12); obstructive jaundice of non-calculous etiology (excluding tumor genesis) (n = 8). The results of physiological parameters collected from the patient records were evaluated according to the POSSUM and P-POSSUM scores. Then the predicted rates of morbidity and mortality of all studied groups were compared with the observed rates and a statistical analysis was carried out. Results. Using the POSSUM incidence score, the observed versus expected ratio of 0.89 showed no difference (P = 0.969). Using mortality scores POSSUM and P-POSSUM, ratios of observed and expected 0.75, 1.03, respectively, were obtained; the differences were not significant (p = 0.653, p = 0.889). All two points were comparable on the receiver response curve. Conclusions. POSSUM accurately predicted mortality and morbidity in patients undergoing surgery for obstructive jaundice. The study showed that POSSUM can identify patients who needed special attention during treatment.

Keywords:POSSUM, risk assessment system, obstructive jaundice, operational risk, physiological and operational assessment of severity.