Risk-adjusted scoring systems can predict surgeons' performance in colorectal surgery

Area of Science:

• Colorectal Surgery
• Surgical Audit
• Predictive Modeling

Background:

• The Physiological & Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) is a validated audit tool for risk-adjusted operative mortality.
• Its applicability to predicting outcomes specifically in colorectal surgery performed by different surgical specialists requires investigation.

Purpose of the Study:

• To evaluate the accuracy of risk-adjusted scoring systems, specifically POSSUM and CR-POSSUM, in predicting outcomes of major colorectal operations.
• To compare the outcomes of colorectal procedures performed by colorectal surgeons (coloproctologists) versus non-colorectal surgeons.

Main Methods:

• A prospective study of 899 consecutive patients undergoing major elective and emergency colorectal procedures between 2002 and 2004.
• Thirty-day mortality was the primary outcome, compared against POSSUM-predicted mortality.
• Statistical analysis included Hosmer-Lemeshow and Fisher's Exact tests to compare outcomes between surgical groups.

Main Results:

• CR-POSSUM emerged as the most accurate predictive model for major colorectal operations.
• Overall mortality was 7% for coloproctologists (5% elective, 13% emergency) versus 17% for non-coloproctologists (3% elective, 21% emergency).

Conclusions:

• CR-POSSUM demonstrated superior predictive accuracy over POSSUM for colorectal surgery outcomes.
• Coloproctologists achieved significantly lower overall mortality, though not specifically in emergency cases.
• Further research with larger cohorts is needed to compare elective colorectal resection outcomes between surgical specialists.