POSSUM、P-POSSUM和Cr-POSSUM对结直肠癌患者住院期间病死率预测能力的比较

目的 比较并发症和病死率的生理和手术严重性评分(physiological and operative severity score for the enumeration of mortality and morbidity,POSSUM)、并发症和病死率的生理和手术严重性评分(Portsmouth POSSUM,P-POSSUM)、结直肠切除的并发症和病死率的生理和手术严重性评分(colorectal POSSUM,Cr-POSSUM)对结直肠癌患者住院期间病死率的预测能力.方法 调查北京大学第三医院1992-2005年903例结直肠癌外科手术切除的资料.903例中,结肠癌518例,直肠癌385例.用ROC曲线分析判断评分的判别能力,用Hosmer-Lemeshow检验判断评分的拟合优度,用不同危险因素群的O∶E值判断评分的预测能力.结果 903例患者住院期间的病死率为1.0%(9/903).POSSUM、P-POSSUM、Cr-POSSUM预测的病死率分别为5.6%、2.8%、4.8%,三种评分预测的病死率明显高于实际的病死率,O:E值分别为0.18、0.35、0.2.结论 POSSUM、P-POSSUM和Cr-POSSUM在结直肠癌手术中预测的病死率高于实际病死率.     

POSSUM、(P、Cr)-POSSUM、APGBI评分系统预测结直肠癌术后死亡率的研究

目的：评价POSSUM、（P、Cr）-POSSUM、APGBI评分系统对预测结直肠癌术后死亡率的效果。方法：采用POSSUM、（P、Cr）-POSSUM、APGBI评分系统预测120例结直肠癌患者（分为中年组、老年组、总体）术后死亡率，并比较实际发生率与理论预测率的差异。结果：120例结直肠癌患者中，实际死亡率为1．67％（2例），中年组实际死亡率0％，老年组实际死亡率2．67％。POSSUM、P—POSSUM预测各组死亡率均高于实际水平；Cr—POSSUM、APGBI评分系统在预测总体水平及老年组时，理论预测率与实际死亡率比较无明显差异（x^2=0．839，P〉0．05），而预测中年患者预测值稍高于实际水平。结论：APGBI及Cr-POSSUM评分系统能较准确地评估结直肠癌患者手术风险性。     

五种结直肠癌评分系统对中国患者的预测价值

目的 评价5种结直肠癌评分预测系统对中国结直肠癌患者术后病死率的预测能力.方法 回顾性研究904例结直肠癌手术病例,其中结肠癌525例,直肠癌379例.分别使用Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity(POSSUM)、Portsmouth POSSUM(P-POSSUM)、colorectal POSSUM (CR-POSSUM)、Association of Coloproctology of Great Britain and Ireland (ACPGBI)、Cleveland Clinic Foundation Colorectal Cancer Model (CCF-CCM)5种评分系统,对结直肠癌患者术后30 d内病死率进行预测.将预测结果与实际情况进行比较,并比较各系统之间的预测能力.主要通过受试者工作特征曲线(receiver operator characteristic curve,ROC)判断各评分系统的判别能力.结果 各评分系统的ROC曲线下面积分别为POSSUM 0.882,P-POSSUM 0.885,CR-POSSUM 0.844,ACPGBI0.78,CCF-CCM 0.809. 结论 5种结直肠癌预测评分系统对于中国患者的预测高于实际情况.POSSUM,P-POSSUM,CR-POSSUM对中国结直肠癌术后患者30 d病死率的预测好于ACPGBI、CCF-CCM系统.     

POSSUM、P-POSSUM、Cr-POSSUM及新评分系统对中国结直肠癌患者术后死亡率的预测

RenL、UpadhyayAM及WangL比较好计算死亡率及并发症发病率的生理学和手术侵袭度评分系统（POSSUM）、朴茨茅斯评分系统（P—POSSUM）和结直肠评分系统（Cr-POSSUM）预测中国结直肠癌患者外科手术死亡率的准确性,同时开发新的评分系统以提高其预测准确性。     

基于预测评分系统的高龄结直肠癌患者术后并发症的预防策略

目的探讨高龄结直肠癌患者术后并发症发生的危险因素和预防策略。方法收集2006年1月至2009年12月间北京大学人民医院胃肠外科收治并行手术治疗的107例高龄结直肠癌患者（75岁以上）的临床资料。应用POSSUM、E．POSSUM评分系统预测术后并发症发生率,并用ROC曲线及实际例数／预测例数（O／E）比值评估其效度：采用Logistic回归分析影响并发症发生的独立危险因素。结果E．POSSUM和POSSUM评分系统预测术后并发症发生率分别为13．9％。86．6％（平均32．7％）和19．1％～99．1％（平均55．5％）,E—POSSUM评分系统优于POSSUM评分系统[ROC曲线下面积（AUC值）：0．862比0．576];O／E：0．771比0．454,更加接近于实际并发症发生率（25．2％,27／107）。术前合并糖尿病（P=0．019）和发病部位为直肠（P=0．005）是手术相关并发症的独立危险因素：吻合口瘘为最常见的手术相关并发症;术前合并慢性阻塞性肺病（P=0．026）、术前ASA分级（P_0．025）、术前肠梗阻（P=0．037）及术前肠穿孔（P=0．001）是非手术相关并发症的独立危险因素：肺部感染是最常见的非手术相关并发症。结论术前应用E—POSSUM评分系统可对高龄结直肠癌患者术后并发症发生率进行较为准确的预测：对于并发症发生高危患者术前应积极干预高危因素．以预防术后并发症的发生。     

POSSUM和P-POSSUM评分系统对老年股骨颈骨折手术风险的预测研究

目的 探讨生理学和手术严重度评分系统,即POSSUM和P-POSSOM评分系统,对老年股骨颈骨折手术的手术风险预测价值.方法 首都医科大学附属北京友谊医院骨科于2010年1月-2012年5月收治因股骨颈骨折行人工关节置换手术治疗的老年患者108例,应用POSSUM和P-POSSUM评分系统预测患者手术病死率和并发症发病率,分析人工髋关节置换手术风险预测值和观察值之间的差异.同时对病例资料进行分组比较,分析不同组别间的预测情况是否存在差异.结果 根据POSSUM评分系统预测,47例患者术后发生并发症,平均并发症发病率为43.52％,而实际发生并发症37例,实际并发症发病率为34.26％,预测值与实际值差异无统计学意义(P=0.238);预测11例死亡,平均病死率为10.19％,实际死亡2例,实际病死率为1.85％,预测值明显高于实际值.根据P-POSSUM评分系统预测的病死率(预测死亡4例,平均病死率为3.70％,实际死亡2例,实际病死率为1.85％),预测值与实际值差异无统计学意义(P=0.625).以POSSUM评分得分40分为界分组,两组并发症发病率及病死率的预测值与实际值分组比较差异无统计学意义(P =0.527,P =0.285).结论 POSSUM评分系统能较好地预测老年股骨颈骨折手术患者并发症发病率,但过高估计手术病死率;P-POSSUM评分系统能准确地预测手术病死率,对于高危组患者的预测结果尤为满意.     

改良POSSUM评分系统在高龄普外科患者中的应用

目的评价改良POSSUM评分系统在高龄普外科病人中的应用价值。方法回顾性分析245例75岁以上的普外科手术病人的术后并发症率和死亡率，并与改良POSSUM评分系统预测的结果进行比较。结果改良POSSUM评分系统预测的并发症发生率为49.80％，死亡率为14.29％。实际并发症发生率为35.51％，死亡率为4.89％。结论在高危组病例中改良POSSUM评分系统更具有使用价值。     

基于预测评分系统的高龄结直肠癌患者术后并发症的预防策略

目的 探讨高龄结直肠癌患者术后并发症发生的危险因素和预防策略.方法 收集2006年1月至2009年12月间北京大学人民医院胃肠外科收治并行手术治疗的107例高龄结直肠癌患者(75岁以上)的临床资料.应用POSSUM、E-POSSUM评分系统预测术后并发症发生率,并用ROC曲线及实际例数／预测例数(O/E)比值评估其效度;采用Logistic回归分析影响并发症发生的独立危险因素.结果 E-POSSUM和POSSUM评分系统预测术后并发症发生率分别为13.9％～86.6％(平均32.7％)和19.1％～99.1％(平均55.5％),E-POSSUM评分系统优于POSSUM评分系统[ ROC曲线下面积(AUC值):0.862比0.576];O/E:0.771比0.454,更加接近于实际并发症发生率(25.2％,27/107).术前合并糖尿病(P=0.019)和发病部位为直肠(P=0.005)是手术相关并发症的独立危险因素;吻合口瘘为最常见的手术相关并发症;术前合并慢性阻塞性肺病(P=0.026)、术前ASA分级(P=0.025)、术前肠梗阻(P=0.037)及术前肠穿孔(P=0.001)是非手术相关并发症的独立危险因素;肺部感染是最常见的非手术相关并发症.结论 术前应用E-POSSUM评分系统可对高龄结直肠癌患者术后并发症发生率进行较为准确的预测;对于并发症发生高危患者术前应积极干预高危因素,以预防术后并发症的发生.     

POSSUM评分系统预测肝癌患者术后并发症发生率及病死率的意义

目的 :探讨POSSUM评分系统预测肝癌患者术后并发症发生率及病死率的临床意义。方法 :2009~2014年294例手术治疗的肝癌患者进行POSSUM及P-POSSUM评分,预测术后并发症发生率及病死率,并分别与实际并发症发生率及病死率比较。结果:POSSUM评分系统预测并发症发生率18%(53/294),实际发生率14%(42/294),差异无统计学意义(P=0.218),预测病死率5.1%(15/294),实际病死率1.02%(3/294),差异有统计学意义(P=0.004)。P-POSSUM预测病死率2.4%(7/294),实际病死率1.02%(3/294),差异无统计学意义(P=0.339)。结论:POSSUM评分系统能够较准确地预测肝癌患者术后并发症的发生率,但高估了术后病死率,P-POSSUM预测术后病死率更为准确。     

POSSUM及P-POSSUM对胃肠外科手术风险度的评价

目的探讨术前使用POSSUM和P-POSSUM评分系统对预测胃肠外科患者术后并发症和病死率的准确性。方法以POSSUM和P-POSSUM各项指标及常见临床影响因素为参考,对近1年内泸州医学院附属医院普外科收治的633例胃肠外科手术患者进行前瞻性的评估,并与患者实际并发症、死亡情况进行比较。以Logistic回归分析,非参数独立样本t检验,ROC曲线,预测和实际病死率及并发症符合度(OE比率)等统计学方法评价POSSUM及P-POSSUM预测的准确性。结果POSSUM预测并发症发生数为229例,实际发生数为188例;P-POSSUM预测死亡数为44例,实际死亡数为34例,差异均无统计学意义(P0.05);在高危机组(R138,R250)预测更具准确性,预测和实际病死率和并发症率符合度等于1;而在低危机组(R138,R250)则其死亡发生率被高估,预测和实际病死率和并发症率符合度大于1。多因素Logistic回归分析显示,肝功能、血糖、体高比、手术时间和术中血压的平稳因素与术后并发症和病死率均有相关性。结论对于胃肠外科患者,POSSUM预测其并发症率和P-POSSUM预测其病死率有良好的相关性。     

Mortality rate prediction by Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM), Portsmouth POSSUM and Colorectal POSSUM and the development of new scoring systems in Chinese colorectal cancer patients

Background

The aim of this study was to compare the Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), Portsmouth POSSUM (P-POSSUM), and Colorectal POSSUM (Cr-POSSUM) for predicting surgical mortality in Chinese colorectal cancer patients and to create new scoring systems to achieve better prediction.

Methods

Data from 903 patients undergoing surgery for colon and rectal cancers from 1992 to 2005 at Peking University Third Hospital were included in this study. POSSUM, P-POSSUM, and Cr-POSSUM were used to predict mortality. Stepwise logistic regression was used to develop the modified P-POSSUM and Cr-POSSUM. Their performances were tested by receiver operating characteristic curve, Hosmer-Lemeshow statistic, and observed:expected ratio.

Results

The actual inpatient mortality was 1.0% (9 of 903). The predicted mortality of POSSUM, P-POSSUM, and Cr-POSSUM were 5.6%, 2.8%, and 4.8%, respectively, which were significantly higher than the actual mortality in our cohort. The predicted mortality of the modified P-POSSUM and Cr-POSSUM was very close to the observed mortality. Both the modified models offered better accuracy than P-POSSUM.

Conclusions

The predicted mortality of POSSUM, P-POSSUM, and Cr-POSSUM were significantly higher than the observed mortality in our patients. The modified P-POSSUM and Cr-POSSUM models provided an accurate prediction of inpatient mortality rate in colorectal cancer patients in China.     

Comparison of the possum, P-POSSUM and Cr-POSSUM scoring systems as predictors of postoperative mortality in patients undergoing major colorectal surgery

BACKGROUND: Physiologic and operative severity score for the enumeration of mortality and morbidity (POSSUM), 'Portsmouth'-physiologic and operative severity score for the enumeration of mortality and morbidity (P-POSSUM) and 'Colorectal'-physiologic and operative severity score for the enumeration of mortality and morbidity (Cr-POSSUM) are three related scoring systems, which uses individual patient parameters to predict postoperative mortality. POSSUM overpredicts mortality in low-risk patients and underpredicts mortality in elderly and emergency patients. P-POSSUM was developed to compensate for these weaknesses. Cr-POSSUM was developed specifically for colorectal surgery. We aim to establish which of these scoring systems would be most useful in an Australasian context. METHODS: Data were collected for 308 patients and predicted mortality risk values were generated using each of the three systems. The Mann-Whitney U-test was then carried out on the scores for each system. Receiver-operator characteristic curves were designed to determine the relative accuracy of each approach at discriminating between death and survival. RESULTS: All three POSSUM scoring systems showed a statistically significant ability to predict postoperative mortality. Additionally, in each system there was a significant difference in the raw physiologic and operative severity scores between survivors and those who died. A risk-stratification model was applied to each set of data, showing a correlation between an increase in risk and an increase in mortality rate. Finally, the receiver-operator characteristic curves generated showed that in this study group POSSUM, P-POSSUM and Cr-POSSUM were all satisfactory predictive tools although the latter tended to be relatively less accurate. CONCLUSION: Physiologic and operative severity score for the enumeration of mortality and morbidity, P-POSSUM and Cr-POSSUM are all reliable predictors of postoperative mortality in the Australasian context; although there was a trend towards POSSUM and P-POSSUM being better predictors than Cr-POSSUM. However, Cr-POSSUM requires fewer individual patient parameters to be calculated and is thus easier to generate. An ideal preoperative scoring system remains to be developed for predicting mortality in patients undergoing colorectal surgery.     

结直肠癌评分系统对术后病死率预测能力的研究

目的 评估大不列颠和爱尔兰结直肠协会(Association of Coloproctology of Great Britain and Ireland,ACPGBI)评分系统在国内的临床应用价值.方法 回顾性分析1992-2005年904例结直肠癌患者的临床资料,其中结肠癌525例,直肠癌379例.按照手术时机、疾病种类将病例分为急诊手术组、非急诊手术组;结直肠专科医师手术组、其他外科医师手术组;结肠癌组、直肠癌组.分别计算各组预测病死率,根据ACPGBI评分计算预测结果,并与实际结果进行比较.数据采用t检验、x2检验、受试者工作特征曲线-ROC(receiver operator characteristic curve)、拟合优度(goodness-of-fit)检验、不同危险因素群的O:E比,并分组进行评判.结果 术后30天内实际病死率1.0%(9/904).ACPGBI预测病死率为8.3%(75/904).对于急诊手术组、非急诊手术组、专科医生手术组、非专科医生手术组、结肠癌组和直肠癌组,预测值均偏高.病死率预测高的组,实际病死率也高.结论 ACPGBI预测病死率高于结直肠癌手术后实际病死率.ACPGBI预测结直肠癌手术后病死率的趋势,有一定临床意义.     

Risk-adjusted prediction of operative mortality in oesophagogastric surgery with O-POSSUM

INTRODUCTION: The present study was designed to develop a dedicated oesophagogastric model for the prediction of risk-adjusted postoperative mortality in upper gastrointestinal surgery (O-POSSUM). METHODS: Using 1042 patients undergoing oesophageal (n = 538) or gastric (n = 504) surgery between 1994 and 2000 the Portsmouth predictor equation for mortality (P-POSSUM) scoring system was compared with a standard logistic regression O-POSSUM model and a multilevel O-POSSUM model using the following independent factors: age, physiological status, mode of surgery, type of surgery and histological stage. RESULTS: The overall mortality rate was 12.0 per cent (elective mortality rate 9.4 per cent and emergency mortality rate 26.9 per cent). P-POSSUM overpredicted mortality (14.5 per cent), particularly in the elective group of patients. The multilevel model offered higher discrimination than the single-level O-POSSUM and P-POSSUM models (area under receiver-operator characteristic curve 79.7 versus 74.6 and 74.3 per cent). When observed to expected outcomes were evaluated, the multilevel O-POSSUM model was found to offer better calibration (Hosmer-Lemeshow chi(2) statistic 10.15 versus 10.52 and 28.80). CONCLUSION: The multilevel O-POSSUM model provided an accurate risk-adjusted prediction of death from oesophageal and gastric surgery for individual patients. In conjunction with a multidisciplinary approach to patient management, the model may be used in everyday practice for perioperative counselling of patients and their carers.     

Evaluation of P-POSSUM and CR-POSSUM Scores in Patients with Colorectal Cancer Undergoing Resection

Introduction The aim of this study was to evaluate the predictive accuracy of P-POSSUM and CR-POSSUM models on patients undergoing colorectal resection. Methods P-POSSUM and CR-POSSUM predictor equations for mortality were applied retrospectively to 321 patients who had undergone colorectal resection for cancer. P-POSSUM and CR-POSSUM scores were validated by assessing their calibration and discrimination. Calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test and the corresponding calibration curves. Evaluation of the discriminative capability of both models was performed using receiver-operating characteristic (ROC) curve analysis. Results Overall, 22 deaths were observed. CR-POSSUM predicted 25 deaths (χ² = 12.20, P = 0.13), and P-POSSUM predicted 29 deaths (χ² =18.85, P = 0.002). ROC curves analysis revealed that CR-POSSUM has reasonable discriminatory power for mortality. Conclusions These data suggest that CR-POSSUM may provide a better estimate of the risk of mortality for patients who undergoing colorectal resection.     

Can SAPS II Predict Operative Mortality More Accurately Than POSSUM and P-POSSUM in Patients with Colorectal Carcinoma Undergoing Resection?

Background This study assessed the APACHE II (Acute Physiology and Chronic Health Evaluation II), SAPS II (Simplified Acute Physiology Score-II), POSSUM (Physiologic and Operative Severity Score for Enumeration of Morbidity and Mortality), and P-POSSUM (Portsmouth-POSSUM) in patients with colorectal cancer undergoing curative or palliative resection. Methods Predicted mortality rates and the observed/expected mortality ratio were computed by means of each scoring system. The results were compared between survivors and nonsurvivors and between elective and emergency operations. Each model was assessed for its accuracy to predict the risk of death using receiver operator characteristic (ROC) curve analysis, and risk stratification was generated as well. Results Some 224 patients were enrolled in the study. The overall 30-day mortality rate was 3.6% (n = 8). Predicted mortality rates generated by APACHE II, SAPS II, POSSUM, and P-POSSUM were 9.1%, 3.7%, 13.4%, and 5.2%, respectively. All the scoring systems assigned higher scores to those patients who died than to those who survived. Areas under the curve calculated by ROC curve analysis for APACHE II, SAPS II, POSSUM, and P-POSSUM were 0.786, 0.854, 0.793, and 0.831, respectively. Best stratification was achieved by the SAPS II score. Conclusions SAPS II and P-POSSUM were determined to be better predictors for patients with colorectal cancer undergoing resection. SAPS II also was found to have a higher degree of discriminatory power in colorectal resection for carcinoma. The predictive value of this useful severity score in several surgical subgroups must be examined to evaluate its routine use in risk-adjusted audit.     

Prospective comparison of POSSUM and P-POSSUM with clinical assessment of mortality following emergency surgery

BACKGROUND: Tools to accurately estimate the risk of death following emergency surgery are useful adjuncts to informed consent and clinical decisions. This prospective study compared the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) scoring systems with clinical judgement in predicting mortality from emergency surgery. METHODS: Data were collected prospectively from 163 patients. Details of the physiological and operative severity scores were recorded for POSSUM and P-POSSUM. The estimates of both the surgeon and anaesthetist for 30-day and in-hospital mortality were also recorded pre-operatively. The accuracies of the four predictions were then compared with actual mortalities using linear and exponential analysis and receiver operator characteristics (ROC). RESULTS: P-POSSUM gave the most accurate prediction of 30-day mortality using linear analysis [observed to expected ratio (O : E) = 1.0]. POSSUM gave the most accurate prediction using exponential analysis (O : E = 1.15). Clinical judgement of mortality from both operating surgeons and anaesthetists compared favourably with the scoring systems for 30-day mortality (O : E = 0.83 and O : E = 0.93, respectively). ROC analyses showed both clinical judgement and the POSSUM scores to be good predictors of 30-day mortality with area under the curve values (AUC) of 0.903, 0.907, 0.946 and 0.940 for surgeons, anaesthetists, POSSUM and P-POSSUM respectively. CONCLUSIONS: POSSUM and P-POSSUM appear to be useful indicators for the prediction of mortality. Clinical judgement compares strongly with scoring systems in predicting post-operative mortality, but may underestimate mortality in very high-risk patients with more than 90% mortality.     

Prospective Evaluation of In-hospital Mortality with the P-POSSUM Scoring System in Patients Undergoing Major Digestive Surgery

Background

The P-POSSUM score, the most well known of predictive scores for postoperative mortality, requires validation for population and setting.

Methods

Validation methods included discrimination (C-index statistic), observed:expected (O:E) ratio, calibration with the Hosmer-Lemeshow test, and subgroup analysis (emergency surgery, cancer, age, organs). The study included 3,881 multisite patients undergoing major digestive surgery in France.

Results

Discrimination via the receiver operating characteristic curve was good (C-index?=?0.87). The overall O:E ratio was 1 (95% confidence interval ([95 % CI]: 0.88–1.13), and therefore the quality of the surgical performance is within normal ranges. The O:E ratio, calculated by risk ranges, showed overestimation in the low risk range, especially in the 3 % to 6 % and 6 % to 10 % ranges. Calibration was poor (p?<?0.001). The model deviated from the normal pattern of calibration, with mortality lower than expected in the high-risk range. Subgroup analysis found reasonable to good discrimination of populations (C-index ranging from 0.78 to 0.93 except for liver surgery [0.67]) while calibration of individuals remained poor (p?<?0.001 to 0.02).

Conclusions

Good discrimination, as well as nonsignificant overall O:E values, makes P-POSSUM a valuable tool when it is used for surgical audit to compare mortality between populations for major digestive surgery. Conversely, poor calibration (goodness-of-fit), especially in subgroup analysis, and underestimation or overestimation of O:E ratios considerably limits the value of P-POSSUM for prediction of mortality in individuals. Therefore P-POSSUM should not be used to predict outcomes for one particular patient.     

Can elderly patients with colorectal cancer tolerate planned surgical treatment? A practical approach to a common dilemma

Aim  Analysing the effectiveness of a surgical procedure is mandatory in every modern health-care system. The aging of the population stresses the need for a good standard of care. This study tests the hypothesis that porthsmouth-physiologic operative severity score for enumeration of morbidity and mortality (P-POSSUM) and colorectal-POSSUM (CR-POSSUM) would be useful clinical auditing tools in colorectal cancer surgery for aged patients.
Method  One hundred and seventy-seven consecutive patients over 70 years of age underwent emergency or elective surgery from January 2003 to December 2005. Demographic, clinical and surgical information, score systems' prediction, complications and 30-day mortality data were prospectively entered in a comprehensive database. The observed over expected morbidity and mortality rate was calculated.
Results  Thirty-day observed mortality was 10.3% (19/177) while P-POSSUM and CR-POSSUM expected mortality were, respectively, 11.21% ( P  = NS) and 13.08% ( P  = NS). Overall observed morbidity was 42.7%, P-POSSUM prediction was 59.3% ( P  = 0.002). Morbidity and mortality data were analysed for specific subgroups of patients (resection and anastomosis/resection and stoma/palliative; emergency/elective).
Conclusion  P-POSSUM and CR-POSSUM are useful tools to predict mortality in elderly patients. P-POSSUM significantly overestimated the risk of complications. A more accurate tool for preoperative assessment for aged patients is probably needed to predict the post-surgical outcome.