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Comparison of individual surgeon's performance. Risk-adjusted analysis with POSSUM scoring system

P M Sagar1, M N Hartley, J MacFie

  • 1Royal Liverpool University Hospital, Liverpool, United Kingdom.

Diseases of the Colon and Rectum
|June 1, 1996
PubMed
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Comparing surgeon performance after colorectal resection requires risk adjustment. The Physiological and Operative Severity Score for the enUrologists and Surgeons (POSSUM) system provides a validated method for comparing outcomes and reducing bias.

Area of Science:

  • Colorectal surgery outcomes research
  • Surgical quality assessment
  • Health services research

Background:

  • Direct comparison of surgeon outcomes using crude morbidity and mortality rates is challenging due to variations in patient case mix and fitness.
  • Crude outcome rates can be misleading and do not account for patient-specific risk factors.

Purpose of the Study:

  • To compare the outcomes of colorectal resections performed by five different surgeons.
  • To utilize the Physiological and Operative Severity Score for the enUrologists and Surgeons (POSSUM) system for risk-adjusted analysis.

Main Methods:

  • A prospective study of 438 patients undergoing colorectal resection by one of five surgeons.
  • Collection of demographic details, operative procedures, and postoperative courses.

Related Experiment Videos

  • Determination of physiologic and operative severity scores using the POSSUM system to calculate individual patient risk for morbidity and mortality.

    • Main Results:

    • Observed morbidity rates varied from 13.6% to 30.6% and 30-day mortality rates from 4.5% to 6.9% among the surgeons.
    • Risk-adjusted analysis using POSSUM showed predicted morbidity and mortality closely matched observed outcomes for each surgeon.
    • POSSUM effectively accounted for patient risk factors, enabling a more accurate comparison of surgical performance.

    Conclusions:

    • Crude comparison of surgeon performance based on unadjusted morbidity and mortality rates is unreliable.
    • Risk-adjusted analysis, such as that provided by POSSUM, offers a more meaningful and equitable method for evaluating individual surgeon outcomes.
    • Implementing validated scoring systems is crucial for accurate surgical quality assessment in colorectal procedures.