POSSUM: A tool to predict morbidity & mortality in HNFFS
Research type
Research Study
Full title
POSSUM: A tool to predict morbidity & mortality in Head and Neck Free Flap Surgery
IRAS ID
178846
Contact name
Neil Scott
Contact email
Sponsor organisation
Research and Development Department. Abertawe Bro Morgannwg University Health Board
Duration of Study in the UK
2 years, 0 months, 2 days
Research summary
Risk prediction in Head and Neck Free Flap Surgery (HNFFS) is becoming increasingly important in measuring surgical outcome, with particular focus upon the assessment of consultant and unit performance. POSSUM scoring is a validated and widely used risk stratification tool in General surgery, Vascular surgery and Oesophagogastric surgery. However, there is currently no such version in HNFFS.
The original description of POSSUM by Copeland et al was as a tool to compare morbidity and mortality in General surgical procedures. Copeland et al set out to adjust the risk of a surgical procedure based on the patients physiological condition and therefore allow a more accurate comparison of consultant and unit performance. The POSSUM score focuses on 12 physiological and 6 operative parameters. Logistic regression equation was used to produce a percentage for a specific patients morbidity and mortality risk
In relation to Head and Neck Surgery (HNS), Griffiths et al undertook a retrospective study in which 301 HNS patients were POSSUM scored. The authors concluded that POSSUM scoring in HNS did not accurately predict mortality. However, more noteworthy was the introduction of 2 new variables to the equation; previous radiotherapy (p = 0.002) and previous surgery (p = 0.007). The authors stated that these 2 variables are “worthy of inclusion in a POSSUM score for head and neck surgery”. It was also noted that certain physiological and operative parameters are not suitable to be included in a HNS POSSUM score, such as peritoneal contamination and Glasgow Coma Scale. No further work was undertaken.
Tighe et al looked at the application of POSSUM in 245 HNS patients. The author concluded that POSSUM score in its current General surgery format was not suitable for use in Head and Neck surgery.It is evident that there is a need for a validated, easy to use risk prediction tool in HNS.
REC name
Wales REC 6
REC reference
15/WA/0136
Date of REC Opinion
20 Apr 2015
REC opinion
Favourable Opinion