Evaluation of various POSSUM models for predicting mortality in patients undergoing elective oesophagectomy for carcinoma

• Published in: British journal of surgery Vol. 94; no. 9; pp. 1172 - 1178
• Main Authors: Lai, F., Kwan, T. L., Yuen, W. C., Wai, A., Siu, Y. C., Shung, E.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-09-2007; Wiley
• Subjects: Biological and medical sciences; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - surgery; Epidemiology; Esophageal Neoplasms - mortality; Esophageal Neoplasms - surgery; Esophagectomy - mortality; Female; General aspects; Humans; Male; Medical sciences; Middle Aged; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression Analysis; Risk Factors; ROC Curve; Severity of Illness Index; Human; Medicine; Evaluation; Carcinoma; Treatment; Surgery; Mortality; Patient; Models; Malignant tumor; Epidemiology
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.5793

Background:
The aim of the study was to validate the use of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM), Portsmouth (P) POSSUM and upper gastrointestinal (O) POSSUM models in patients undergoing elective thoracic oesophagectomy for carcinoma.
Methods:
The observed in‐hospital mortality rates in 545 patients undergoing elective thoracic oesophagectomy for squamous cell carcinoma of the oesophagus in all public hospitals in Hong Kong was compared with rates predicted by POSSUM, P‐POSSUM and O‐POSSUM. The discriminatory power of these models was assessed using receiver–operator characteristic (ROC) curve analysis.
Results:
The observed mortality rate was 5·5 per cent, whereas rates predicted by POSSUM, P‐POSSUM and O‐POSSUM were 15·0, 4·7 and 10·9 per cent respectively. P‐POSSUM showed no lack of fit (P = 0·814), but POSSUM (P < 0·001) and O‐POSSUM (P = 0·002) showed lack of fit against observed mortality. POSSUM overpredicted mortality across nearly all risk groups, whereas O‐POSSUM overpredicted mortality in patients with low physiological scores and in older patients. POSSUM (area under ROC curve 0·776) and P‐POSSUM (0·776) showed equally good discriminatory power but O‐POSSUM (0·676) was inferior.
Conclusion:
P‐POSSUM provided the most accurate prediction of in‐hospital mortality in this group of patients who had elective oesophagectomy. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
P‐POSSUM was best