Surgical audit using the POSSUM scoring tool in vascular surgery patients

Area of Science:

• Vascular Surgery
• Surgical Outcomes Assessment
• Health Services Research

Background:

• Current methods using crude morbidity and mortality rates may not accurately reflect quality of care in high-risk vascular surgery.
• There is a need for more precise tools to assess surgical performance.

Purpose of the Study:

• To evaluate the Physiological and Operative Severity Score for the enUrological Mortality (POSSUM) score as a performance measure in a vascular unit.
• To assess the POSSUM score's utility in predicting individual patient outcomes.

Main Methods:

• A prospective study of 106 patients undergoing vascular surgery.
• Vascular-POSSUM scores were calculated for each patient.
• Predicted and observed morbidity and mortality rates were compared using statistical tests and receiver operator characteristic (ROC) curves.

Main Results:

• POSSUM scores showed a significant association with mortality endpoints (Area Under ROC Curve = 0.97250).
• Predicted morbidity (41%) was not significantly different from observed morbidity (35.8%).
• POSSUM tended to over-predict mortality (9.7% predicted vs. 5.7% observed).

Conclusions:

• The POSSUM score is a valuable tool for surgical audit in vascular surgery.
• High POSSUM mortality scores can identify patients at elevated risk.
• Wider implementation of the POSSUM score is recommended for interpreting surgical outcomes.