The Value Of POSSUM System In Prognostic Risk Assessment Of Distal Pancreatectomy

Objective:The objective of our research is to discuss the clinical value of POSSUM scoring system in estimating the risk of postoperative pancreatectomy(DP)and to evaluate the accuracy of the POSSUM scoring system.Then explored the risk factors of complications after distal pancreatectomy.Methods:Clinical data of 99 patients undergoing distal pancreatectomy were collected.From January 2004 to February 2019,in the First Affiliated Hospital of Nanchang University.According to the Possum prediction system scoring criteria,PS and OS were performed on all patients.The score value was substituted into the logistic regression equation to obtain the predicted complication incidence and mortality rate,and compared with the actual postoperative complication incidence and mortality rate,so as to judge the prediction accuracy of the regression equation.The risk factors of postoperative complications were analyzed by single factor analysis and multivariate analysis,and independent risk factors were obtained.SPSS21.0 statistical software was used for analysis in this paper.Single factor analysis was performed by chi-square test,and multi-factor analysis was performed by binomial Logistic regression analysis.P < 0.05 was considered statistically significant.Results:There were 39 cases(39.39%)developing postoperative complications in 99 cases,including 26 cases(26.6%)of pancreatic fistula,5 cases(5.05%)of abdominal hemorrhage,20 cases(20.20%)of abdominal infection,6 cases(6.06%)of peritoneal effusion,9cases(9.09%)of pulmonary infection,2 cases(2.02%)of delayed gastric emptying,and 2 patients(2.02%)died within 30 days after surgery.The physiologic index of patients was 15.99±2.72,the surgical severity index was 16.33±3.19,and the total POSSUM score was 32.32±4.76.The incidence of complications predicted by the POSSUM system was 43.78%,and the actual was 39.39%.by the chi-square test,P > 0.05,no statistical differences as a result,accurately predict the patients with postoperative complications.The POSSUM predicted mortality was 10.48%,the actual mortality was 2.02%,by the chi-square test,P < 0.05,indicating that the results were statistically different,the POSSUM would overestimate postoperative mortality;P-POSSUM to predict mortality was 2.94%,which was compared with the actual mortality rate,the chi-square test,P > 0.05,no statistical differences as a result,accurately predict patients postoperative mortality.O:E value and ROC curve were used to evaluate the accuracy of the system in predicting the incidence of complications.Single factor analysis showed that age,gender,basic diseases,surgical procedure,blood loss,the nature and size of the tumor,has nothing to do with complications,Operative time,texture of pancreas and albumin on the first day after surgery were related to complications.Multivariate analysis showed that operative time was an independent risk factor for complications.Conclusions:The POSSUM scoring system has a certain accuracy in predicting the incidence of complications after distal pancreatectomy,while the predicted mortality is significantly higher.The P-POSSUM predicts that postoperative mortality is more accurate.Operative time and texture of the pancreas albumin on the first day after surgery were related to complications after pancreatectomy,and operative time was an independent risk factor.