The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM)

Neary, W.D.; Heather, B. P.; Earnshaw, J. J.

doi:10.1002/bjs.4041

Cited by 148 publications

(124 citation statements)

References 35 publications

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“…Patient care is the responsibility of individual surgeons, but outcomes often depend on a large multidisciplinary team comprising surgeons, anesthetists, intensive care staff, junior doctors, and nurses. Where an audit shows a change in morbidity rates and a significant increase in the O-to-E ratio, the practice of the entire team should be reviewed [3]. Overreaction should be avoided, and the causes of deficiencies in quality should P=0.000 be carefully examined.…”

Section: Interpretation Of Predictionmentioning

confidence: 99%

“…The unit that selects only low-risk cases achieves a low complication rate and therefore attracts more patients, whereas the unit that cannot select only low-risk cases is left with a worsening case mix [1]. Monitoring crude death rates can mask the effects of case mix; surgeons who work in impoverished inner-city hospitals or tertiary referral centers may feel disadvantaged compared with their colleagues who elect to treat fit patients or work in an affluent area [3].…”

Section: Introductionmentioning

confidence: 99%

“…Physiological and operative severity score for the enumeration of morbidity and mortality (POSSUM) has been proposed as a method for standardizing patient data so that direct comparisons of patient outcomes can be made [2]. There are many scoring systems; but, to date, POSSUM is the most promising for auditing surgery, and it has been extensively used in various surgical specialties [3,4]. It is a reliable instrument for comparing internal audits of the same unit during two different periods [5].…”

Section: Introductionmentioning

confidence: 99%

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Effect of surgical work volume on postoperative complication: superiority of specialized center in gastric cancer treatment

Sah

Zhu

Chen

et al. 2008

Langenbecks Arch Surg

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Purpose We investigated the risk factors for early postoperative complications after gastric cancer surgery. Materials and methods The data from a total of 273 patients with gastric cancer were analyzed by univariate and multivariate analysis. We applied physiological and operative severity score for the enumeration of morbidity and mortality (POSSUM) to compare risk-adjusted surgical outcomes among different surgical units. Results Among the preoperative variables, patient gender, chronic obstructive pulmonary disease, surgical unit, and intraoperative blood loss were independent risk factors for a higher rate of postoperative complications. There were significant differences in complication rates among different surgical units (P=0.001). The observed-to-expected morbidity ratio (O-to-E ratio) ranged from 0.81 to 1.63. Units with low surgical work volume had higher complication rates. Postoperative length of stay was significantly shorter (P=0.000) and the rate of moderate and severe complications was significantly lower (P=0.001) in specialized unit.Conclusions POSSUM is a valid system for risk-adjusted evaluation of surgical outcomes. We conclude that surgical experience and work volume greatly influence the outcome, with overall surgical outcome in specialized centers superior to that in other units. Hence, gastric cancer surgery should be performed in specialized centers. Risk factors identified in this study need further confirmation by a prospective study involving a larger cohort.

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Section: Interpretation Of Predictionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of surgical work volume on postoperative complication: superiority of specialized center in gastric cancer treatment

Sah

Zhu

Chen

et al. 2008

Langenbecks Arch Surg

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“…The main value of this scoring system is the scientific method used for its development [3][4][5], together with its simplicity. Different validation studies carried out [6,7] have found mortality overprediction, especially among patients with low surgical risk.…”

Section: Introductionmentioning

confidence: 99%

“…Both POSSUM and P-POSSUM scores have proved to be reliable mortality predictors for patients undergoing general and special surgery [1,4,5,8]. When applied specifically to colorectal surgery, these scoring systems have been found to overpredict mortality in elective surgical procedures and to underpredict mortality in elderly patients and in cases of emergency surgery [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Analysis of POSSUM score and postoperative morbidity in patients with rectal cancer undergoing surgery

Valentí

Hernández-Lizoain

Baixauli

et al. 2008

Langenbecks Arch Surg

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Background The Physiological and Operative Severity Score for the enUmeration of Mortality andmorbidity (POSSUM) and later modifications (P-POSSUM y CRPOSSUM) have been used to predictmorbidity and mortality rates among patients with rectal cancer undergoing surgery. These calculations needsome adjustment, however. The aim of this study was to assess the applicability of POSSUM to a group ofpatients with rectal cancer undergoing surgery, analysing surgical morbidity by means of several variables. Methods between January 1995 and December 2004, 273 consecutive patients underwent surgery forrectal cancer. Information was gathered about the patients, tumour and therapy. To assess the predictioncapacity of POSSUM, subgroups for analysis were created according to variables related to operativemorbidity and mortality. Results The global morbidity rate was 23.6% (31.2% predicted by POSSUM). The mortality rate was 0.7% (6.64, 1.95 and 2.08 predicted by POSSUM, P-POSSUM and CR-POSSUM respectively). POSSUMpredictions may be more accurate for patients younger than 51 years, older than 70 years, with low anaesthetic risk (ASA I/II), DUKES stage C and D, surgery duration of less than 180 minutes and for thosereceiving neoadjuvant therapy. Conclusion POSSUM is a good instrument to make results between different institutions and publicationcomparable. We found prediction errors for some variables related to morbidity. Modifications of surgicalvariables and specifications for neoadjuvant therapy as well as physiological variables including life stylemay improve future prediction of surgical risk. More research is needed to identify further potential riskfactors for surgical complications.

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Comparison of P-POSSUM and Cr-POSSUM Scores in Patients Undergoing Colorectal Cancer Resection

Horžić

Kopljar²,

Čupurdija³

et al. 2007

Arch Surg

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at our institution were enrolled in the study.Main Outcome Measures: P-POSSUM and Cr-POSSUM scores were calculated for each patient. Inhospital mortality rate and number of deaths within 30 days after surgery were recorded. The ratio of observed to expected deaths was calculated for each analysis.Results: The P-POSSUM system underpredicted mortality by 25%, with no significant difference between the predicted and observed values (P=.96). The observed to expected ratio for Cr-POSSUM was 1.11, with no significant difference between the observed and predicted values (P=.19). Area under the receiver operating curve for P-POSSUM was 0.70 and for Cr-POSSUM was 0.59.Conclusions: Both P-POSSUM and Cr-POSSUM perform well in predicting mortality after colorectal cancer surgery, but the Cr-POSSUM is more accurate. There is a constant need for reevaluation of existing and any new scoring systems outside original development and validation populations. The Cr-POSSUM score is a promising specialized tool for monitoring surgical outcomes in colorectal cancer surgery.

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The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM)

Cited by 148 publications

References 35 publications

Effect of surgical work volume on postoperative complication: superiority of specialized center in gastric cancer treatment

Effect of surgical work volume on postoperative complication: superiority of specialized center in gastric cancer treatment

Analysis of POSSUM score and postoperative morbidity in patients with rectal cancer undergoing surgery

Comparison of P-POSSUM and Cr-POSSUM Scores in Patients Undergoing Colorectal Cancer Resection

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