O-POSSUM and P-POSSUM as predictors of morbidity and mortality in older patients after hip fracture surgery: a meta-analysis

BackgroundThe POSSUM model has been widely used to predict morbidity and mortality after general surgery. Modified versions known as O-POSSUM and P-POSSUM have been used extensively in orthopedic surgery, but their accuracy is unclear. This systematic review evaluated the predictive value of these models in older patients with hip fractures.MethodsThis study was performed and reported based on the Preferred reporting items for systematic reviews and meta-analyses guidelines. PubMed, Cochrane, EMBASE, and Web of Science were comprehensively searched for relevant studies, whose methodological quality was evaluated according to the Methodological index for non-randomized studies scale. Revman 5 was used to calculate weighted ratios of observed to expected morbidity or mortality.ResultsThe meta-analysis included 10 studies, of which nine (2549 patients) assessed the ability of O-POSSUM to predict postoperative morbidity, nine (3649 patients) assessed the ability of O-POSSUM to predict postoperative mortality, and four (1794 patients) assessed the ability of P-POSSUM to predict postoperative mortality. The corresponding weighted ratios of observed to expected morbidity or mortality were 0.84 (95% CI 0.70-1.00), 0.68 (95% CI 0.49-0.95), and 0.61 (95% CI 0.16-2.38).ConclusionsWhile O-POSSUM shows reasonable accuracy in predicting postoperative morbidity in older patients with hip fractures, both P-POSSUM and O-POSSUM substantially overestimate postoperative mortality. The POSSUM model should be optimized further for this patient population.

Automated summary

This systematic review evaluated the accuracy of the POSSUM models in predicting morbidity and mortality in older patients with hip fractures. The results showed that while O-POSSUM had reasonable accuracy in predicting postoperative morbidity, both P-POSSUM and O-POSSUM substantially overestimated postoperative mortality. Further optimization of the POSSUM model is needed for this patient population.