The Possum Scoring System and Complete Blood Count in the Prediction of Complications After Pancreato-Duodenal Area Resections

• Authors: Iwona Dębińska , Katarzyna Smolińska , Jakub Osiniak , Piotr Paluszkiewicz
• Languages of publication: EN

Abstracts

EN

The introduction of markers which help in the identification of patients prone to suffer from postoperative complications enables to recognize them more easily and thus, treat them more effectively.The aim of the study was to evaluate complete blood count indicators, as well as preoperative results obtained on the basis of the POSSUM and P-POSSUM scoring systems, considering the prediction of complications after surgical resections in the pancreato-duodenal area.Material and methods. A prospective 30-day non-interventional clinical study was conducted on a group of 65 patients who underwent scheduled surgery, due to pancreatic head cancer or chronic pancreatitis. Total pancreatoduodenectomy was performed in 24.1% of patients, while the remaining were subject to hemi-pancreatoduodenectomy. The authors evaluated the preoperative complete blood count parameters, as well as the risk of complications and mortality using the audit POSSUM and P-POSSUM scoring systems.Results. Postoperative complications were observed in 32.4% of patients. The white blood cell count and platelet count in the preoperative period were statistically lower in the group of patients with postoperative complications, in comparison to patients without diagnosed complications. Higher severity scores obtained by means of the P-POSSUM scoring system, as well as higher mortality during the perioperative period can be ascribed to patients who suffered postoperative complications. However, no correlation was found between the occurrence of complications and gender, age, type of resection, preoperative hemoglobin level, absolute lymphocyte count, or numerical value representing the patient's general condition (POSSUM) and predicted postoperative morbidity.Conclusions. The absolute white blood cell count and total platelet count during the preoperative period may be considered as an indicator of the higher risk of complications during pancreato-duodenal area resections. The usefulness of the POSSUM and P-POSSUM scoring systems is limited. However, the surgical severity index and calculated mortality coefficient risk can facilitate the identification of patients threatened with postoperative complications.

Keywords

EN

complete blood count; surgical severity index; POSSUM and P-POSSUM scoring systems; pancreato-duodenal area; pancreatoduodenectomy

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2011
• Volume: 83
• Issue: 1
• Pages: 10-18

Dates

published

1 - 1 - 2011

online

14 - 3 - 2011

Contributors

author

Iwona Dębińska

• Department of Surgery and Surgical Nursing, Medical University in Lublin

author

Katarzyna Smolińska

• Department of Surgery and Surgical Nursing, Medical University in Lublin

author

Jakub Osiniak

• Department of General Surgery, St John Regional Hospital in Lublin

author

Piotr Paluszkiewicz

References

• Buchler MW, Wagner M, Schmied BM et al.: Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg 2003; 138: 1310-14.
• Muller-Nordhorn J, Bruggenjurgen B, Bohmig M et al.: Direct and indirect costs in a prospective cohort of patients with pancreatic cancer. Aliment Pharmacol Ther 2005; 22: 405-15.
• DeOliveira ML, Winter JM, Schafer M et al.: Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 2006; 244: 931-37.
• DiCarlo V, Balzano G, Zerbi A et al.: Pancreatic cancer resection in elderly patients. Br J Surg 1998; 85: 607-10.
• Gilsdorf RB, Spanos P. Factors influencing morbidity and mortality in pancreaticoduodenectomy. Ann Surg 1973; 177: 332-37.
• Gouma DJ, van Geenen RC, van Gulik TM et al.: Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 2000; 232: 786-95.
• House MG, Fong Y, Arnaoutakis DJ et al.: Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg 2008; 12: 270-78.
• Klek S, Kulig J, Sierzega M et al.: Standard and immunomodulating enteral nutrition in patients after extended gastrointestinal surgery-a prospective, randomized, controlled clinical trial. Clin Nutr 2008; 27: 504-12.
• Bassi C, Falconi M, Salvia R et al.: Management of complications after pancreaticoduodenectomy in a high volume centre: results on 150 consecutive patients. Dig Surg 2001; 18: 453-57.
• Muscari F, Suc B, Kirzin S et al.: Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients. Surgery 2006; 139: 591-98.
• Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg 1991; 78: 355-60.
• Whiteley MS, Prytherch DR, Higgins B et al.: An evaluation of the POSSUM surgical scoring system. Br J Surg 1996; 83: 812-15.
• Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-13.
• McPhee JT, Hill JS, Whalen GF et al.: Perioperative mortality for pancreatectomy: a national perspective. Ann Surg 2007; 246: 246-53.[WoS]
• Donati A, Ruzzi M, Adrario E et al.: A new and feasible model for predicting operative risk. Br J Anaesth 2004; 93: 393-99.
• Schnelldorfer T, Adams DB. Should elective surgery for chronic pancreatitis be performed in high-risk patients? Am Surg 2006; 72: 592-97.
• Okabayashi T, Kobayashi M, Nishimori I et al.: Risk factors, predictors and prevention of pancreatic fistula formation after pancreatoduodenectomy. J Hepatobiliary Pancreat Surg 2007; 14: 557-63.
• Noun R, Riachy E, Ghorra C et al.: The impact of obesity on surgical outcome after pancreaticoduodenectomy. JOP 2008; 9: 468-76.
• Eichenberger A, Proietti S, Wicky S et al.: Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg 2002; 95: 1788-92.
• Carson JL, Duff A, Poses RM et al.: Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet 1996; 348: 1055-60.
• Spence RK, Carson JA, Poses R et al.: Elective surgery without transfusion: influence of preoperative hemoglobin level and blood loss on mortality. Am J Surg 1990; 159: 320-24.
• Bauhofer A, Plaul U, Torossian A et al.: Perioperative prophylaxis with granulocyte colony-stimulating factor (G-CSF) in high-risk colorectal cancer patients for an improved recovery: A randomized, controlled trial. Surgery 2007; 141: 501-10.
• Nakchbandi IA, Lohr JM. Coagulation, anticoagulation and pancreatic carcinoma. Nat Clin Pract Gastroenterol Hepatol 2008; 5: 445-55.
• Schwarz RE, Keny H: Preoperative platelet count predicts survival after resection of periampullary adenocarcinoma. Hepatogastroenterology 2001: 48: 1493-98.[PubMed]
• Dominguez I, Crippa S, Thayer SP et al.: Preoperative platelet count and survival prognosis in resected pancreatic ductal adenocarcinoma. World J Surg 2008; 32: 1051-56.[WoS]
• Fitzgerald JR, Foster TJ, Cox D: The interaction of bacterial pathogens with platelets. Nat Rev Microbiol 2006; 4: 445-57.
• Clark EJ, Connor S, Taylor MA et al.: Preoperative lymphocyte count as a prognostic factor in resected pancreatic ductal adenocarcinoma. HPB (Oxford) 2007; 9: 456-60.
• Bann SD, Sarin S: Comparative audit: the trouble with POSSUM. J R Soc Med 2001: 94: 632-34.
• de Castro SM, Houwert JT, Lagard SM et al.: POSSUM Predicts Survival in Patients with Unresectable Pancreatic Cancer. Dig Surg 2009; 26: 75-79.
• Khan AW, Shah SR, Agarwal AK et al.: Evaluation of the POSSUM scoring system for comparative audit in pancreatic surgery. Dig Surg 2003; 20: 539-45.

Identifiers

DOI

10.2478/v10035-011-0002-z