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A model for national outcome audit in vascular surgery
D R Prytherch1, B M Ridler, J D Beard
1St. Mary's Hospital, Portsmouth, UK.
Summary
The Physiological and Operative Severity Score for enUrological Surgery (POSSUM) scoring system effectively predicts mortality and morbidity in vascular surgery patients. Adding extra patient data did not improve prediction accuracy, indicating POSSUM alone is sufficient for outcome assessment.
Area of Science:
- Vascular Surgery
- Surgical Outcomes Research
- Health Services Research
Background:
- Predicting patient outcomes is crucial for quality improvement in vascular surgery.
- The Physiological and Operative Severity Score for enUrological Surgery (POSSUM) is a widely used scoring system.
Purpose of the Study:
- To model and predict vascular surgical outcomes using the POSSUM scoring system in a national study.
- To evaluate the predictive accuracy of POSSUM and additional "extra items" for mortality and morbidity.
Main Methods:
- Logistic regression analysis of 1313 patient records from 121 British and Irish surgeons.
- Utilized P-POSSUM methodology with standard POSSUM data and "extra items".
- Data split into training and testing sets for prospective model validation.
Main Results:
- POSSUM data items alone accurately predicted both mortality and major postoperative complications after arterial reconstruction.
- Inclusion of "extra items" did not significantly enhance predictive accuracy.
- Preoperative physiology components of POSSUM were sufficient for accurate outcome prediction.
Conclusions:
- P-POSSUM methodology is a reliable tool for predicting vascular surgery outcomes across diverse surgical settings.
- The system can serve as a foundation for national outcome audits in arterial surgery.
- POSSUM physiology scores alone provide accurate models for predicting mortality and major morbidity.