APACHE II, POSSUM, and ASA scores and the risk of perioperative complications in patients with oral or oropharyngeal cancer.

BACKGROUND: The indications for surgical treatment of patients with head and neck cancer can be limited by the risk of perioperative complications. Prediction of outcome is important in disease stratification and the subsequent decision-making process.

OBJECTIVE: To assess the value of the APACHE II (Acute Physiology and Chronic Health Evaluation II) score, POSSUM (Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity), and ASA (American Society of Anesthesiologists) classification in the prediction of complications in patients with oral or oropharyngeal cancer.

METHODS: Five hundred thirty patients with oral or oropharyngeal carcinomas who underwent surgical treatment were evaluated using ASA, POSSUM, and APACHE II scores. The outcome measure was morbidity within 30 days. Logistic regression and receiver operating characteristic curve analyses were used to estimate the predictive ability of the scoring systems.

RESULTS: The overall complication rate was 58.9%. Most of the patients had local complications. The mortality was 2.6%. The results showed that APACHE II (relative risk, 1.09; P =.001) and POSSUM (relative risk, 1.09; P<.001) equally predicted perioperative complications and were superior to the ASA system (relative risk, 0.98; P =.89) (area under the curve, 0.65 for APACHE II, 0.68 for POSSUM, and 0.56 for ASA).

CONCLUSIONS: The POSSUM and APACHE II scores were useful in predicting perioperative morbidity for patients with oral or oropharyngeal cancer, serving as objective methods to assist the surgeon in classifying patients into risk groups with different probabilities of perioperative complications. The poorer results achieved with the ASA classification are possibly because this system is primarily based on subjective clinical judgments.