Assessing Surgical Quality: Comparison of General and Procedure-Specific Morbidity Estimation Models for the Risk Adjustment of Pancreaticoduodenectomy Outcomes

Introduction The use of outcomes to evaluate surgical quality implies the need for detailed risk adjustment. The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a generally applicable risk adjustment model suitable for pancreatic surgery. A pancreaticoduodenectomy (PD)-specific intraoperative pancreatic risk assessment (IPRA) estimates the risk of postoperative pancreatic fistula (POPF) and associated morbidity based on factors that are not incorporated into POSSUM. Objective The aim of the study was to compare the risk estimations of POSSUM and IPRA in patients undergoing PD. Methods An observational single-center cohort study was conducted including 195 patients undergoing PD in 2008–2010. POSSUM and IPRA data were recorded prospectively. Incidence and severity of postoperative morbidity was recorded according to established definitions. The cohort was grouped by POSSUM and IPRA risk groups. The estimated and observed outcomes and morbidity profiles of POSSUM and IPRA were scrutinized. Results POSSUM-estimated risk (62 %) corresponded with observed total morbidity (65 %). Severe morbidity was 17 % and in-hospital-mortality 3.1 %. Individual and grouped POSSUM risk estimates did not reveal associations with incidence ( p = 0.637) or severity ( p = 0.321) of total morbidity or POPF. The IPRA model identified patients with high POPF risk ( p