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Related Experiment Videos

Comparison of individual urologists' performance.

F Sommer1, A Ehsan, T Klotz

  • 1Department of Urology, University Medical Centre of Cologne, and Paracelsus Klinik Golzheim, Düsseldorf, Germany. Frank.Sommer@uni-koeln.de

European Urology
|April 18, 2001
PubMed
Summary

Crude surgical outcomes can be misleading. The Physiological and Operative Severity Score for the enUrological Mortality (POSSUM) system provides a more realistic comparison of urologist performance by accounting for patient fitness and procedure complexity.

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Area of Science:

  • Urology
  • Health Services Research
  • Surgical Outcomes

Background:

  • Comparative outcome statistics in healthcare are crucial but can be misleading.
  • Crude mortality and morbidity rates do not account for patient fitness or procedure complexity.
  • Accurate quality assessment requires standardized risk-adjustment methods.

Purpose of the Study:

  • To compare crude operative morbidity and mortality rates with predicted rates using the POSSUM scoring system.
  • To evaluate the reliability of crude outcome statistics in urological surgery.
  • To determine if the POSSUM system offers a more realistic assessment of surgical performance.

Main Methods:

  • A prospective study comparing 5 urological operations performed by 2 urologists over 12 months.

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  • Utilized the Physiological and Operative Severity Score for the enUrological Mortality (POSSUM) system.
  • POSSUM incorporates preoperative physiological status, postoperative status, and complication data.

    • Main Results:

    • Urologist 1: 160 patients, 2.5% mortality, 31.3% morbidity. Urologist 2: 144 patients, 0.7% mortality, 9% morbidity.
    • POSSUM predicted mortality: Urologist 1 (3.1%), Urologist 2 (0.7%). Predicted morbidity: Urologist 1 (35%), Urologist 2 (10.4%).
    • Receiver operating curve analysis showed no significant difference in outcomes between the two urologists when adjusted by POSSUM.

    Conclusions:

    • Crude mortality and morbidity figures can be misleading when comparing surgeons.
    • The POSSUM system provides a more realistic and standardized comparison of urological surgeons' performance.
    • Risk-adjusted analysis using POSSUM is essential for accurate quality assessment in urology.