ObjectiveThe Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) model and its Portsmouth (P-POSSUM) modification are used extensively to predict post-operative mortality and morbidity in general surgery. The aim was to analysis the predictive value of these models in patients undergoing hepatobiliary surgery. MethodsEligible articles were identified by searching such electronic databases as PubMed, The Cochrane Library (Issue 10, 2013), Science Citation Index, CNKI, WanFang Data and CBM from 1991 to October 2013. Each study was assessed according to the inclusion and exclusion criteria. Then data were extracted, pooled, and analyzed using Comprehensive Meta Analysis Version 2. ResultsTen studies were included. The morbidity analysis included five studies and 683 patients on POSSUM with a weighted O/E ratio 0.71 (95%CI 0.60 to 0.81). The mortality analysis included seven studies with 1 291 patients on POSSUM and six studies with 1 793 patients on P-POSSUM. Weighted O/E ratios for mortality were 0.42 (95%CI 0.27 to 0.57) for POSSUM and 0.74 (95%CI 0.53 to 0.95) for P-POSSUM. ConclusionPOSSUM significantly overestimates postoperative morbidity in patients undergoing hepatobiliary surgery. Compared with the original POSSUM, P-POSSUM is more accurate for predicting post-operative mortality. Modifications to POSSUM and P-POSSUM are needed for audit in hepatobiliary surgery.
ObjectiveTo explore the predictive value of four risk scoring systems for cardiovascular complications during pregnancy in patients with congenital heart disease (CHD). MethodsComputer searches were conducted in PubMed, EMbase, CENTRAL, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, and China Biology Medicine disc (CBM). Relevant studies on risk scoring systems for cardiovascular complications during pregnancy in CHD patients at home and abroad were comprehensively collected. The retrieval period was from the establishment of the databases to January 1, 2025, and the retrieval was updated on March 26, 2025. After two reviewers independently screened the literature and extracted the data, the quality assessment was carried out, and Meta-analysis was performed using MedCalc software. ResultsA total of 11 studies were included, with a total of 4 987 patients. The incidence of cardiovascular complications during pregnancy in CHD patients ranged from 6.72% to 28.84%. The QUADAS-2 scoring tool results showed that two studies had a risk of bias, and nine studies were determined to have a high risk of bias. The results of the Meta-analysis showed that the CARPREGⅠ score [AUC=0.709, 95%CI (0.672, 0.745), P<0.001], CARPREGⅡ score [AUC=0.757, 95%CI (0.720, 0.794), P<0.001], ZAHARA score [AUC=0.732, 95%CI (0.674, 0.790), P<0.001], and mWHO classification system [AUC=0.681, 95%CI (0.617, 0.745), P<0.001] could independently predict cardiovascular complications during pregnancy in CHD patients. ConclusionThe existing evidence indicates that all four scoring systems can be used to predict cardiovascular complications during pregnancy in CHD patients. Although the CARPREGⅡ score has the highest accuracy, the number of included studies is small. It is recommended to give priority to using the ZAHARA score for risk stratification and pregnancy management of women with CHD before pregnancy. In view of the limitations of the quality of the included studies, this study needs to be further confirmed by high-quality studies.