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Comparative vascular audit using the POSSUM scoring system

G P Copeland1, D Jones, A Wilcox

  • 1Warrington District General Hospital.

Annals of the Royal College of Surgeons of England
|May 1, 1993
PubMed
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Using the Physiological and Operative Severity Score for the enUmerged Surgical Morbidity (POSSUM) system, this study found no significant difference in vascular surgery outcomes between two hospitals when accounting for patient factors. POSSUM analysis aids comparative surgical audits.

Area of Science:

  • Vascular Surgery
  • Surgical Audit
  • Health Services Research

Background:

  • Overall mortality and morbidity figures in comparative surgical audits can be misleading.
  • Variations in surgical procedures and patient fitness are not accounted for in simple outcome comparisons.

Purpose of the Study:

  • To compare vascular surgery outcomes between two hospitals.
  • To assess the utility of the Physiological and Operative Severity Score for the enUmerged Surgical Morbidity (POSSUM) system in comparative surgical audits.

Main Methods:

  • A comparative audit of vascular surgery outcomes was conducted over a 9-month period in two hospitals.
  • The Physiological and Operative Severity Score for the enUmerged Surgical Morbidity (POSSUM) system was used to adjust for patient fitness and surgical severity.

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  • Receiver operating curve (ROC) analysis was employed to compare the performance of the two units.

    • Main Results:

    • Hospital A: 255 patients, 9.4% mortality, 37.3% morbidity.
    • Hospital B: 89 patients, 20.2% mortality, 47.2% morbidity.
    • POSSUM-adjusted predicted mortality: 10.2% (Hospital A) vs. 20.2% (Hospital B).
    • POSSUM-adjusted predicted morbidity: 38.4% (Hospital A) vs. 50.6% (Hospital B).
    • ROC analysis revealed no significant difference in outcomes between the two units after POSSUM adjustment.

    Conclusions:

    • Simple comparative audits of mortality and morbidity can be misleading in vascular surgery.
    • The POSSUM scoring system can help standardize comparisons by accounting for patient and operative factors.
    • POSSUM analysis is a valuable tool for more accurate comparative surgical audits.