Clinical Analysis Of Application Of APACHE-Ⅱ, POSSUM And P-POSSUM Scoring System In Pancreatoduodenectomy

Objective: Utilize APACHE-II, POSSUM and P-POSSUM scoring system to predictmortality and morbidity of pancreatoduodenectomy, which will be compared with the actualincidence, so as to discuss the clinical application of APACHE-II, POSSUM and P-POSSUMscores in predicting operation risk of pancreatoduodenectomy; and to seek and establish anobjective and accurate, scoring method to predict pancreatoduodenectomy resection operationrisk; it’s good for understanding of the disease, reducing operation risks ofpancreatoduodenectomy surgical operation risk, reduce deuteropathies, so that patients get theoptimal profit by integrated treatment based on operation.Methods: Collect original medical records of142pancreatoduodenectomy casesperformed in General Hospital of Ningxia Medical University from January2003toDecember2012, calculate the observed values of deuteropathy and mortality, compare thepreoperative expected values of deuteropathy and mortality calculated on the basis ofAPACHE-Ⅱ, POSSUM and P-POSSUM scoring method with the actual values; valuate thevalue of each scoring system in clinical work by statistical analysis (the statistical data weresubjected to t test, measurement data to χ2test and Z test, and P<0.05, which shows statisticsignificance; evaluate the judgement ability of scoring methods by ROC curves).Results: In142inpatients,58cases of deuteropathy occured (41%), namely: pancreaticfistula (n=25, morbidity=17.6%), intra-abdominal infection (n=14,morbidity=9.9%), delayedgastric emptying (n=10, morbidity=7.0%), postpancreatectomy hemorrhage (n=8,morbidity=5.6%), biliary fistula (n=3,morbidity=2.1%). Seven out of142inpatients died during hospitalization, and the mortality was4.9%, of which the main causes of death weremultiple organ failure.POSSUM scoring system predicted that the deuteropathy rate is57.4％(82/142), which is different from the actual deuteropathy rate in statistic.. APACHE-Ⅱpredicted22patients died (mortality=15.8%), which had a significant difference withcomparison to the observed death cases. POSSUM predicted18patients died (mortality=12.9%), which had a significant difference with comparison to observed death cases.Whereas P-POSSUM exhibited7patients (mortality=4.9%), compared with observedmortality, which had no significant differences.Conclusion: APACHE-II score significantly overestimate the risk of death in operations.The POSSUM score can not accurately predict mortality of operation. P-POSSUM scoringsystem can predict mortality and deuteropathies of pancreatoduodenectomy, and can helpcarry out preoperative risk assessment more accurately, so as to reduce the operation risk,improve the operation safety, and to provide protection for diagnosis and treatment. POSSUMscore and P-POSSUM score have a certain guiding significance in selection of Rx andperioperation management.