Risk-adjusted analysis of surgeon performance: A 1-year study

Abstract

A 1-year prospective analysis was undertaken of all non-day-case general surgery in a district general hospital. Using the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scoring system 3004 patients were assessed. From the predictions of mortality and morbidity so obtained, a quality measure, the ratio of observed to expected numbers of deaths and complications (O:E ratio) was determined for each surgeon, both overall and within specialty zones. The present study demonstrates the serious hazard in using 'raw' uncorrected mortality and morbidity statistics to compare surgeon performance. Mortality rates varied from 1.0 to 4.9 per cent whereas O:E ratios ranged from 0.83 to 1.06; morbidity rates varied from 5.3 to 12.6 per cent with O:E ratios 0.86-1.02. Great misunderstanding may result from the publication of surgeon or hospital 'league tables'. The present study demonstrates a technique that might allow surgeon performance to be monitored adequately and accurately.

Usefulness of POSSUM Physiological Score for the Estimation of Morbidity and Mortality Risk After Elective Abdominal Aortic Aneurysm Repair in Japan

“…One of the most popular systems for surgical patients has been the POSSUM scoring system. This is an effective audit tool for surgical patients in general, 21 but it has been found to give an overestimation of expected mortality rate. 22 As such, validated POSSUM-based models are now being used to assess outcomes in vascular surgery 23 and colorectal surgery.…”

Controlling Nutritional Status is Useful for Predicting Postoperative Complications in very Elderly Patients with Colorectal Cancer: A Retrospective Study

“…In regards to the method of risk assessment in the perioperative period, the operative severity score called, Physiological and operative severity score for the enumeration of mortality and morbidity POSSUM , is well known in European counties, while the physiologic and surgical stress score, Estimation of physiologic ability and surgical stress E-PASS , is known in Japan [8][9][10] . The ef cacy of the modi ed POSSUM has been reported several times [11][12][13] ; however, both POS-SUM and E-PASS are calculated based on preoperative physiological scores and surgical severity scores.…”

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

“…Interestingly, the score was demonstrated to be a good tool to predict major complications or death in the subgroup of patients undergoing spine surgery. It could be hypothesised that the limited utility of the SAS in this cohort of patients undergoing orthopaedic surgery could be secondary to a smaller complication rate compared to general and vascular surgery, since it is not unusual to have a significant number of patients with a risk of death greater than 70 % in general surgery [13]. Our cohort exhibited a lower complication rate compared with the general and vascular surgery validation cohort (5.2 versus 22 %); a low in-hospital complication rate was also reported in a retrospective study assessing the SAS in patients undergoing hip and knee arthroplasties [11].…”