期刊
ANNALS OF MEDICINE AND SURGERY
卷 62, 期 -, 页码 1-9出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.amsu.2020.12.016
关键词
POSSUM; Cardiopulmonary exercise test; Liver and pancreas surgery
POSSUM lacks predictive fit for morbidity in hepatopancreatobiliary surgery, while CPET variables show some predictive power for post-operative outcomes. Developing a new HPB-specific risk prediction tool combining parameters from POSSUM and CPET, along with HPB-specific markers, could overcome current limitations.
Background: Cardiopulmonary exercise-testing (CPET) and the (Portsmouth) Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity ((P)-POSSUM) are used as pre-operative risk stratification and audit tools in general surgery, however, both have been demonstrated to have limitations in major hepatopancreatobiliary (HPB) surgery. Materials and methods: The aim of this review is to determine if CPET and (P)-POSSUM scoring systems accurately predict morbidity and mortality. Eligible articles were identified with an electronic database search. Analysis according to surgery type and tool used was performed. Results: Twenty-five studies were included in the final review. POSSUM predicted morbidity demonstrated weighted O/E ratios of 0.75(95%CI0.57-0.97) in hepatic surgery and 0.85(95%CI0.8-0.9) in pancreatic surgery. P-POSSUM predicted mortality in pancreatic surgery demonstrated an O/E ratio of 0.75(95%CI0.27-2.13) and 0.94(95%CI0.57-1.55) in hepatic surgery. In both pancreatic and hepatic surgery an anaerobic threshold(AT) of between 9 0.5-11.5 ml/kg/min was predictive of post-operative complications, and in pancreatic surgery ventilatory equivalence of carbon dioxide(.VE/.VCO2) was predictive of 30-day mortality. Conclusion: POSSUM demonstrates an overall lack of predictive fit for morbidity, whilst CPET variables provide some predictive power for post-operative outcomes. Development of a new HPB specific risk prediction tool would be beneficial; the combination of parameters from POSSUM and CPET, alongside HPB specific markers could overcome current limitations.
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