Journal of Gastrointestinal Surgery

, Volume 14, Issue 10, pp 1511–1520 | Cite as

A Systematic Review of POSSUM and its Related Models as Predictors of Post-operative Mortality and Morbidity in Patients Undergoing Surgery for Colorectal Cancer

  • Colin Hewitt Richards
  • Fiona E. Leitch
  • Paul G. Horgan
  • Donald C. McMillan
2010 SSAT Plenary Presentation



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.


Major electronic databases, including Medline, Embase, Cochrane Library and Pubmed were searched for original studies published between 1991 and 2010. Two independent reviewers assessed each study against inclusion and exclusion criteria. All data was specific to colorectal cancer surgery. Predictive value was assessed by calculating observed to expected (O/E) ratios.


Nineteen studies were included in final review. The mortality analysis included ten studies (4,799 patients) on POSSUM, 17 studies (6,576 patients) on P-POSSUM and 14 studies (5,230 patients) on CR-POSSUM. Weighted O/E ratios for mortality were 0.31 (CI 0.31–0.32) for POSSUM, 0.90 (CI 0.88–0.92) for P-POSSUM and 0.64 (CI 0.63–0.65) for CR-POSSUM. The morbidity analysis included four studies (768 patients) on POSSUM with a weighted O/E ratio of 0.96 (CI 0.94–0.98).


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.


Mortality Colorectal cancer Surgical scoring systems Systematic review POSSUM P-POSSUM CR-POSSUM 


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Copyright information

© The Society for Surgery of the Alimentary Tract 2010

Authors and Affiliations

  • Colin Hewitt Richards
    • 1
  • Fiona E. Leitch
    • 1
  • Paul G. Horgan
    • 1
  • Donald C. McMillan
    • 1
  1. 1.University Department of SurgeryFaculty of Medicine-University of Glasgow, Royal InfirmaryGlasgowUK

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