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O-POSSUM and P-POSSUM as predictors of morbidity and mortality in older patients after hip fracture surgery: a meta-analysis

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

The POSSUM model has been widely used to predict morbidity and mortality after general surgery. Modified versions known as O-POSSUM and P-POSSUM have been used extensively in orthopedic surgery, but their accuracy is unclear. This systematic review evaluated the predictive value of these models in older patients with hip fractures.

Methods

This study was performed and reported based on the “Preferred reporting items for systematic reviews and meta-analyses” guidelines. PubMed, Cochrane, EMBASE, and Web of Science were comprehensively searched for relevant studies, whose methodological quality was evaluated according to the “Methodological index for non-randomized studies” scale. Revman 5 was used to calculate weighted ratios of observed to expected morbidity or mortality.

Results

The meta-analysis included 10 studies, of which nine (2549 patients) assessed the ability of O-POSSUM to predict postoperative morbidity, nine (3649 patients) assessed the ability of O-POSSUM to predict postoperative mortality, and four (1794 patients) assessed the ability of P-POSSUM to predict postoperative mortality. The corresponding weighted ratios of observed to expected morbidity or mortality were 0.84 (95% CI 0.70–1.00), 0.68 (95% CI 0.49–0.95), and 0.61 (95% CI 0.16–2.38).

Conclusions

While O-POSSUM shows reasonable accuracy in predicting postoperative morbidity in older patients with hip fractures, both P-POSSUM and O-POSSUM substantially overestimate postoperative mortality. The POSSUM model should be optimized further for this patient population.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article.

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Acknowledgements

We would like to thank Home for Researchers (www.home-for-researchers.com) and Armando Chapin Rodriguez, PhD for English language editing.

Funding

This work is supported in China by National Natural Science Foundation of China (82074472); Project of science and technology of the Henan province (222102310368); Heluo Youth Talent Promotion Project (2022HLTJ15).

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Author notes

  1. Guangyao Yang and Guofeng Cui have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedic, Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province, Luoyang, 471000, Henan Province, People’s Republic of China

    Guangyao Yang, Youwen Liu, Jiayi Guo & Chen Yue

  2. Department of Orthopedic, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, 471002, Henan Province, People’s Republic of China

    Guofeng Cui

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  1. Guangyao Yang
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Correspondence to Chen Yue.

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Conflict of interest

We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled, “O-POSSUM and P-POSSUM as predictors of post-operative morbidity and mortality in older hip fracture patients undergoing surgery: a meta-analysis”. The authors declare no competing financial interests.

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Yang, G., Cui, G., Liu, Y. et al. O-POSSUM and P-POSSUM as predictors of morbidity and mortality in older patients after hip fracture surgery: a meta-analysis. Arch Orthop Trauma Surg 143, 6837–6847 (2023). https://doi.org/10.1007/s00402-023-04897-9

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