Conclusions P-POSSUM was the most accurate model for predicting post-operative mortality after colorectal cancer surgery .
The original POSSUM model was accurate in predicting post-operative complications
Introduction The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity  ( POSSUM ) model and its Portsmouth ( P-POSSUM ) and colorectal ( CR-POSSUM ) modifications are used extensively to predict and audit post-operative mortality and morbidity .
This aim of this systematic review was to assess the predictive value of the POSSUM models in colorectal cancer surgery .
Predicting Postoperative Mortality in Patients Undergoing Colorectal Surgery
Well-known and suitable instruments for surgical audit are the POSSUM and P-POSSUM scoring systems . But these scores have not been well vali date d across the countries . The objective of the present study was to assess the predictive value of scores for colorectal surgery in France . Patients operated on for colorectal malignant or diverticular diseases , whether electively or on emergency basis , within a 4-month period were included in a prospect i ve multicenter study conducted by the French Association for Surgery ( Association Française de Chirurgie , AFC ) . The main outcome measure was postoperative in-hospital mortality . Independent factors leading to death were assessed by multivariate logistic regression analysis ( AFC-index ) . The ratio of expected versus observed deaths was calculated , and the predictive value of the POSSUM and P-POSSUM scores were analyzed by the receiver operating characteristic ( ROC ) curve . A total of 1426 patients were included . The in-hospital death rate was 3.4 % . Four independent preoperative factors ( AFC-index ) have been found : emergency surgery , loss of more than 10 % of weight , neurological disease history , and age > 70 years . POSSUM had a poor predictive value ; it overestimated postoperative death in all cases . P-POSSUM had a good predictive value , except for elective surgery , where it overestimated postoperative death twofold . The predictive value of the AFC-index was also good . It had the same sensitivity and specificity as the P-POSSUM . POSSUM has not been vali date d in France in the field of colorectal surgery . P-POSSUM was as predictive as the AFC-index which is a simpler instrument based on four clinical parameters ( without any mathematical formulas )
Conclusions P-POSSUM was the most accurate model for predicting post-operative mortality after colorectal cancer surgery .
The original POSSUM model was accurate in predicting post-operative complications
Introduction The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity  ( POSSUM ) model and its Portsmouth ( P-POSSUM ) and colorectal ( CR-POSSUM ) modifications are used extensively to predict and audit post-operative mortality and morbidity .
This aim of this systematic review was to assess the predictive value of the POSSUM models in colorectal cancer surgery .