K. Akahoshi1, T. Ochiai1, H. Ito1, S. Matsumura1, Y. Mitsunori1, A. Aihara1, D. Ban1, A. Kudo1, S. Tanaka1, M. Tanabe1 1Tokyo Medical And Dental University,Bunkyo-ku, Tokyo, Japan
Introduction: The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) scoring system is one of surgical risk scoring systems to predict postoperative morbidity and mortality, which was originally developed by Copeland in 1991 as a scoring system for surgical audit. The aim of this study was to analyze predictive value of POSSUM scoring system in patients undergoing surgical treatment for hepatocellular carcinoma (HCC).
Methods: All patients who underwent liver resection for HCC in our hospital between September 2010 and February 2012 were enrolled in this study. Various preoperative, intraoperative and postoperative patients’ data were collected retrospectively. POSSUM score was calculated, and estimated morbidity and mortality rates were compared with actual incidences of morbidity and mortality.
Results: A total of 100 patients, with 74 males and 26 females, were studied. The average age was 68.7 years old (range 52-84). Postoperative complications were seen in 31 of 100 patients (31%). There were 2 postoperative in-hospital deaths (2%). Bile leakage was the most common complication (9 cases). Univariate and multivariate analysis revealed that preoperative anemia (HR= 3.886; 95%CI: 1.499 – 10.073, p=0.005) and major hepatectomy (HR= 2.675; 95%CI: 1.064 – 6.729, p=0.037) were independent risk factors of postoperative complications. POSSUM scoring system predicted morbidity risk effectively. Correlation analysis demonstrated that observed morbidity rates were significantly correlated with estimated morbidity rates by POSSUM score (r=0.917). Estimated mortality rates were difficult to evaluate, due to the small number of postoperative in-hospital deaths.
Conclusion: POSSUM scoring system could effectively predict the risk of postoperative morbidity in patients underwent hepatectomy for HCC. POSSUM is expected to be a useful risk assessment system of liver surgery.