Is POSSUM predictive of morbidity and mortality in laryngectomy patients

Abstract Objectives To test the validity of the comparative audit tool of POSSUM (Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity) against a cohort of 92 consecutive laryngectomies at a major tertiary referral centre for head and neck cancer. The major outcome measurements were 30-day mortality rates, formation of a pharyngo-cutaneous fistula, and length of hospital stay. Methods By means of a prospective and retrospective case note analysis. Results No significant difference between the mean POSSUM morbidity scores of those patients who did, or did not develop a fistula, was found ( p  = 0.535, 95% C.I. −4.36 to 8.33). No significant correlation was observed between POSSUM predicted morbidity and bed occupancy [ r  = 0.137 (95% C.I. −0.070 to 0.334)]. The Portsmouth POSSUM equation for mortality however did accurately predict the mortality rate (observed to expected ratio of 1.05). Conclusion The authors propose that whilst there are many similar factors linked to mortality between cohorts of general surgical and head and neck patients, there are several highly specific risk factors in open surgery of the upper aero-digestive tract in the head and neck which are linked with wound breakdown and morbidity which are omitted from the POSSUM scoring system. The authors warn against the use of this comparative audit tool in its current state for such surgical procedures and recommend the creation of a specific POSSUM for head and neck cancer surgery.