Risk-adjusted comparative audit. Is Possum applicable to head and neck surgery?

Area of Science:

• Surgical Outcomes Research
• Health Services Research

Background:

• The Physiological and Operative Severity Score for the Enumeration of Mortality (Possum) is a widely used tool for surgical audit.
• Its applicability and accuracy in the specialized field of head and neck surgery require specific validation.

Purpose of the Study:

• To evaluate the validity of the Possum score for morbidity and mortality prediction in head and neck surgery.
• To assess the predictive accuracy of the Portsmouth Possum (P-Possum) equation in this patient cohort.
• To investigate the impact of radiotherapy and previous surgery on surgical outcomes.

Main Methods:

• Retrospective analysis of 301 operative interventions in head and neck surgery.
• Application of the Possum and P-Possum scoring systems to predict outcomes.
• Inclusion of radiotherapy and previous surgery as novel variables for outcome association analysis.

Main Results:

• The Possum score demonstrated validity for predicting morbidity, with better accuracy in high-risk patient groups.
• Neither the Possum nor the P-Possum score accurately predicted patient mortality.
• Both radiotherapy and previous surgery were significantly associated with the development of postoperative complications (P=0.002 and P=0.007, respectively).

Conclusions:

• The Possum score is a valid tool for assessing morbidity in head and neck surgery.
• Existing Possum and P-Possum scores require refinement for accurate mortality prediction in this specialty.
• Radiotherapy and previous surgery are critical factors influencing postoperative complications and should be considered for inclusion in enhanced head and neck surgical risk assessment models.