Risk-adjusted surgical audit with the POSSUM scoring system in a developing country

Yii, Ming Kon; Ng, Kaspar

doi:10.1046/j.0007-1323.2001.01979.x

Cited by 98 publications

(36 citation statements)

References 14 publications

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“…(37) Though the numbers of personnel and operating theatres are intuitive measures of capacity, the use of mortality rates might be more problematic. Even in developed countries debate continues about comparing mortality rates, as this requires very careful risk adjustment(38). Clearly the volume and complexity of cases also varies significantly from country to country(39).…”

Section: Discussionmentioning

confidence: 99%

Development of a ratio of emergent to total hernia repairs as a surgical capacity metric

Samuel

Tyson

Mabedi

et al. 2014

International Journal of Surgery

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Summary INTRODUCTION Non-communicable diseases including surgical conditions are gaining attention in developing countries. Despite this there are few metrics for surgical capacity. We hypothesized that (a) the ratio of emergent to total hernia repairs (E/TH) would correlate with per capita health care expenditures for any given country, and (b) the E/TH is easy to obtain in resource-poor settings. METHODS We performed a systematic review to identify the E/TH for as many countries as possible (Prospero registry CRD42013004645). We screened 1285 English language publications since 1990; 23 met inclusion criteria. Primary data was also collected from Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. A total of 13 countries were represented. Regression analysis was used to determine the correlation between per capita healthcare spending and the E/TH. RESULTS There is a strong correlation between the log values of the ratio emergent to total groin hernias and the per capita health care spending that is robust across country income levels (R2=0·823). Primary data from KCH was easily obtained and demonstrated a similar correlation. CONCLUSIONS The ratio of emergent to total groin hernias is a potential measure of surgical capacity using data that is easily attainable. Further studies should validate this metric against other accepted health care capacity indicators.

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Section: Discussionmentioning

confidence: 99%

Development of a ratio of emergent to total hernia repairs as a surgical capacity metric

Samuel

Tyson

Mabedi

et al. 2014

International Journal of Surgery

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“…[6] However, the POSSUM scoring systems have been validated and proposed to compare the surgical practice. [7]…”

Section: Discussionmentioning

confidence: 99%

Physiological and operative severity score for the enumeration of mortality and morbidity scoring systems for assessment of patient outcome and impact of surgeons' and anesthesiologists' performance in hepatopancreaticobiliary surgery

2017

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Context:The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a scoring system used to predict morbidity and mortality.Aims:We compared the physiological and operative risk, the expected morbidity and mortality, and the observed postoperative mortality among patients operated by different surgeons and anesthetized by different anesthesiologists.Settings and Design:This was a retrospective, single center study.Subjects and Methods:The anesthetic records of 159 patients who underwent hepatopancreaticobiliary surgery were analyzed for the physiological and operative severity, POSSUM morbidity, POSSUM and Portsmouth POSSUM (P-POSSUM) mortality scoring systems, observed mortality in 30-days, 3, 6, and 12 months postoperatively, duration of surgery, and units of packed red blood cells (PRBC) transfused. These variables were compared among patients operated by five different surgeons and anesthetized by seven different anesthesiologists.Statistical Analysis:One-way analysis of variance was used for normally and Kruskal–Wallis test for nonnormally distributed responses. Differences in percentages of postoperative mortality were assessed by Chi-squared test.Results:The physiological severity, POSSUM morbidity, POSSUM and P-POSSUM mortality scores, and observed mortality at 1, 3, 6, and 12 months postoperatively did not differ among patients operated by different surgeons and anesthetized by different anesthesiologists. Duration of surgery (P < 0.001), PRBC units transfused (P = 0.002), and operative severity (P = 0.001) differed significantly among patients operated by different surgeons.Conclusions:The physiological severity score, POSSUM and P-POSSUM scores did not differ among patients operated by different surgeons and anesthetized by different anesthesiologists. The different operative severity scores did not influence the observed mortality in the postoperative period.

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“…[12][13][14][15][16][17][18][19][20][21] However, the studies mostly have been done in developed countries where patient characteristics, presentation and hospital resources differ from our setup. 22 Hence, there is a need to validate POSSUM in Indian scenario where problems like delayed presentation and limited resources can affect the outcome even with adequate quality care. [23][24][25] In this study, the validity of POSSUM scoring system in 50 patients undergoing emergency laparotomy for perforation peritonitis in a single surgical unit was assessed by comparing the observed and expected mortality and morbidity rates.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of POSSUM scoring system in patients with perforation peritonitis

et al. 2016

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Risk-adjusted surgical audit with the POSSUM scoring system in a developing country

Abstract: The POSSUM scoring system with the modified P-POSSUM predictor equation for mortality was applicable in Malaysia, a developing country, for risk-adjusted surgical audit. This scoring system may serve as a useful comparative audit tool for surgical practice in many geographical locations.

Cited by 98 publications

References 14 publications

Development of a ratio of emergent to total hernia repairs as a surgical capacity metric

Development of a ratio of emergent to total hernia repairs as a surgical capacity metric

Physiological and operative severity score for the enumeration of mortality and morbidity scoring systems for assessment of patient outcome and impact of surgeons' and anesthesiologists' performance in hepatopancreaticobiliary surgery

Evaluation of POSSUM scoring system in patients with perforation peritonitis

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