Application of Portsmouth modification of physiological and operative severity scoring system for enumeration of morbidity and mortality (P-POSSUM) in pancreatic surgery

Research output: Contribution to journalArticlepeer-review


  • Appou Tamijmarane
  • Chandra S Bhati
  • Darius F Mirza
  • David A Mayer
  • John Ac Buckels


BACKGROUND: Pancreatoduodenectomy (PD) is associated with high incidence of morbidity and mortality. We have applied P-POSSUM in predicting the incidence of outcome after PD to identify those who are at the highest risk of developing complications.

METHOD: A prospective database of 241 consecutive patients who had PD from January 2002 to September 2005 was retrospectively updated and analysed. P-POSSUM score was calculated for each patient and correlated with observed morbidity and mortality.

RESULTS: 30 days mortality was 7.8% and morbidity was 44.8%. Mean physiological score was 16.07 +/- 3.30. Mean operative score was 13.67 +/- 3.42. Mean operative score rose to 20.28 +/- 2.52 for the complex major operation (p < 0.001) with 2 fold increase in morbidity and 3.5 fold increase in mortality. For groups of patients with a physiological score of (less than or equal to) 18, the O:P (observed to Predicted) morbidity ratio was 1.3-1.4 and, with a physiological score of >18, the O:P ratio was nearer to 1. Physiological score and white cell count were significant in a multivariate model.

CONCLUSION: P-POSSUM underestimated the mortality rate. While P-POSSUM analysis gave a truer prediction of morbidity, underestimation of morbidity and potential for systematic inaccuracy in prediction of complications at lower risk levels is a significant issue for pancreatic surgery.


Original languageEnglish
Pages (from-to)39
JournalWorld Journal of Surgical Oncology
Publication statusPublished - 2008


  • Adult, Aged, Aged, 80 and over, Databases as Topic, Female, Health Status Indicators, Humans, Incidence, Male, Medical Audit, Middle Aged, Pancreas, Pancreatic Diseases, Pancreatic Neoplasms, Pancreaticoduodenectomy, Prospective Studies, Retrospective Studies, Severity of Illness Index