An assessment of the POSSUM system in orthopaedic surgery

Abstract

We describe the development and validation of a scoring system for auditing orthopaedic surgery. It is a minor modification of the POSSUM scoring system widely used in general surgery. The orthopaedic POSSUM system which we have developed gives predictions for mortality and morbidity which correlate well with the observed rates in a sample of 2326 orthopaedic operations over a period of 12 months. The assessment of outcome after surgical intervention is not a new science. As early as 1750 BC King Hammurabi of Babylon issued a number of decrees relating to surgeons and their surgery. The most infamous of these codices was that if a surgeon operated on a free man and the patient became blind or worse still died, the surgeon should have his operating hand cut off. While, to some a modification of this codex may still seem to be in operation, many have attempted to devise more reliable and robust methods for assessing the outcome of surgical intervention.

Evaluation of a Modified POSSUM Scoring System for Predicting the Morbidity in Patients Undergoing Lumbar Surgery

“…Data on pre-, intra-, and post-operative care were collected manually from hospital computers and paper records. The modified POSSUM scores were collected from the patients as described in Mohamed et al [19].…”

“…Since this pioneering study, there have been various modifications to the scoring system in various surgical fields [2,20,21,24]. In 2002, the original POSSUM equation (using a modified operation classification) was validated in orthopedic surgery [19].…”

New Equations for Predicting Postoperative Risk in Patients with Hip Fracture

“…We predicted the inhospital mortality rates with P-POSSUM [28] and the morbidity and mortality rates 30 days after surgery with O-POSSUM [15]. We used Group B data for prediction of inhospital mortality by P-POSSUM and defined the O/E ratios by linear analysis [29].…”

“…The POSSUM and P-POSSUM systems are the most reliable and widely applicable scoring methods devised to date in general surgery [3,22]. The orthopaedic POSSUM system (O-POSSUM) also has been validated as a method to assess 30-day morbidity and mortality rates in patients having orthopaedic surgery [15]. However, these scoring systems are not practical to predict postoperative risk in patients with hip fractures.…”

Can the Surgical Apgar Score predict morbidity and mortality in general orthopaedic surgery?

“…Although wellestablished postoperative scoring systems to predict outcomes have been developed [1], their complexity hampers their employment in the day-to-day clinical scenario and, most of the time, postoperative risk evaluation depends on subjective clinical evaluation. An inexpensive, objective and easy to use surgical outcome score that could identify patients at high risk for major complications and death would improve patient safety, aid in research and could become a public health tool for quality improvement programmes.…”