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October 1, 1994British journal of surgery

Comparative audit of colorectal resection with the POSSUM scoring system

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Why the study?

Does the POSSUM scoring system allow for a more realistic comparative audit of colorectal resection outcomes between different surgical units compared to crude rates?

Population

248 consecutive patients undergoing colorectal resection

Comparison

Application of the POSSUM scoring system to… vs Crude rates of morbidity and mortality without…

Design

Cohort

Follow-up

30-day

Authors

PSP. M. SagarLeeds Teaching Hospitals NHS TrustMHM HartleyDalhousie UniversityBMB. Mancey-JonesUniversity of Liverpool

Discussion

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Implication

POSSUM-adjusted comparisons may better reflect true unit performance than crude rates; leaves open whether adoption improves audit quality or outcomes.

Key Points

  • To evaluate the utility of the POSSUM scoring system in adjusting for case-mix differences and physiological status during comparative audits of colorectal resection across different surgical units.
  • Assessed consecutive patients undergoing colorectal resection at a university teaching hospital (Unit 1, N=66) and a district general hospital (Unit 2, N=182).
  • Calculated POSSUM-predicted morbidity and mortality and recorded observed postoperative complications and 30-day mortality.
  • Unit 1 (N=66) demonstrated an observed mortality rate of 6% and morbidity rate of 9%, corresponding with POSSUM-predicted rates of 5.2% and 11.2%, respectively.
  • Unit 2 (N=182) exhibited an observed mortality rate of 9% and morbidity rate of 26%, which aligned with POSSUM-predicted rates of 9.8% and 23.9%, respectively.

Structured PICO

Does the POSSUM scoring system allow for a more realistic comparative audit of colorectal resection outcomes between different surgical units compared to crude rates?

P
Population
248 consecutive patients undergoing colorectal resection (n=66 in unit 1, a university teaching hospital; n=182 in unit 2, a district general hospital)
I
Intervention
Application of the POSSUM (Physiological and Operative Severity Score for enUmeration of Mortality and morbidity) scoring system to predict outcomes
C
Comparator
Crude rates of morbidity and mortality without risk adjustment
O
Outcome
Postoperative complications and 30-day mortalityhard clinical

Application of the POSSUM scoring system accounts for variations in case mix, allowing for a more realistic comparative audit of colorectal resection outcomes between different hospitals than crude rates.

Cite This Study

Sagar et al. (1994) studied this question.

synapsesocial.com/papers/6a1bc263ea84844e355ee715https://doi.org/10.1002/bjs.1800811031
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1POSSUM: A scoring system for surgical audit1991 · 1,729 citations
  2. 2Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival.1991 · 549 citations
  3. 3Operative Risk Factors of Colon Resection in the Elderly1980 · 141 citations
  4. 4Comparative audit: Fact <i>versus</i> fantasy1993 · 28 citations
  5. 5Cardiovascular Risk Factors in Patients with Peripheral Vascular Disease1979 · 198 citations