The POSSUM And P-POSSUM Scoring System For Risks Assessment In Hepatectomy Of People Who Had Primary Liver Cancer

Objective: The aim of the study was to evaluate the use of Physiological and Operative Severity Score in the enumeration of mortality and morbidity( POSSUM) and Portsmouth(P)POSSUM scor-ing systems to predict postoperative morbidity and mortality in a g-roup of Chinese patients who had hepatectomy for Primary liver cancer.Methods: 485 cases of Primary liver cancer which were rescted between January 2011 to December 2013 in Hebei Medical University fourth hospital hepatobiliary surgery were summarized retrospectively. POSSUM and P-POSSUM scored the clinical data of preoperative physiological and operative severity and calculated the postoperative expected mortality and morbidity for each case, whilst the observed values were recorded and compared with expected values. And the impact of risk factors in patients with postoperative complications occurred in univariate and multivariate analysis.The statistical analyses were subjected to test for measurement data and Chisquare test for enumeration data using IBM SPSS 20.0 software. multivariate analysis using logistic regression analysis.Difference is statistically significant if P<0.05.Results: Four hundred and eighty-five patients under went hepatectomy,136 cases had complications(28.04%), such as ascites(n=40, morbidity= 8.25%), Infection(n=29,morbidity=7.84%),Pleural effusion(n = 29,morbidity =5.58%),Incision liquefaction(n=17,morbidity=3.51%),bleeding(n=11, morbidity=2.27%), Arrhythmia(n=10,morbidity= 2.06%), Organ failure(n=8,morbidity=1.65%),and in operation 3 cases died(mortality=0.62%)。POSSUM scoring system predicted that 186 cases have got the postoperative complications(expected morbidity=38.40%), between which and observed morbidity had significant differences(Df=1, χ2=11.6, P<0.05); POSSUM predicted 39 patients died, which had a significant difference with comparison to observed death cases(Df=1, χ2=17.97, P<0.05). Whereas P-POSSUM exhibited 10 patients for mortality, compared with observed mortality, which had no significant differences(Df=1, χ2=3.82, P>0.05).Single variant analysis showed that the age, liver function child-pugh, AST,ALB, intraoperative blood loss volume,Whether the line Pringle,PS scores were associated with postoperative complications. Furthermore, multivariate stepwise regression analysis revealed that the liver function child-pugh、Whether the line Pringle and PS scores were the independent risk factors of morbidity rate of resections of Primary liver cancer.Conclusion: The liver function child-pugh,Whether the line Pringle and PS scores were the independent risk factors of morbidity rate of resections of Primary liver cancer. About the hepatectomy for primary liver cancer, POSSUM scoring system overestimated hepatectomy postoperative complications rate and mortality; while P-POSSUM scoring system predict postoperative mortality of patients was more accurate. POSSUM and P-POSSUM scoring system for hepatectomy risk prediction still has certain clinical application value.