The POSSUM System of Surgical Audit

Copeland, G. P.

doi:10.1001/archsurg.137.1.15

Cited by 204 publications

(211 citation statements)

References 17 publications

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“…Overreaction should be avoided, and the causes of deficiencies in quality should P=0.000 be carefully examined. Variations in outcome will occur over time; but if deteriorating O-to-E ratios can be identified early, remedial action can be taken [1].…”

Section: Interpretation Of Predictionmentioning

confidence: 99%

“…Furthermore, the outcome of surgical intervention is not solely dependent on the abilities of the surgeon. The patient's physiological status, the disease that requires surgical correction, the nature of the operation, and the preoperative and postoperative support services have a major effect on the ultimate outcome [1]. Simply collecting outcome data alone is not sufficient to reflect treatment quality because to compare postoperative complication data directly, the original populations must be identical.…”

Section: Introductionmentioning

confidence: 99%

“…Surgeons treating a predominantly young population would be expected to achieve lower complication rates than others serving areas with an elderly population [2]. 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%

“…The POSSUM system allows a numerical prediction of mortality and morbidity for an individual patient, and it enables comparative audits with a method for adjustment of case mix. Comparison can be made over time and can be easily adjusted to radical changes in health care in the future [1,6,7]. In addition, POSSUM has definitions for postoperative complications, which can be used as standard terms while comparing several surgical units.…”

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%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

show abstract

“…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%

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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Understanding the Meaning of Recovery to Patients Undergoing Abdominal Surgery

et al. 2021

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IMPORTANCE Postoperative recovery is difficult to define or measure. Research addressing interventions aimed to improve recovery after abdominal surgery often focuses on measures such as duration of hospital stay and complication rates. Although these clinical parameters are relevant, understanding patients' perspectives regarding postoperative recovery is fundamental to guiding patient-centered care.OBJECTIVE To elucidate the meaning of recovery from the perspective of patients undergoing abdominal surgery. DESIGN, SETTING, AND PARTICIPANTSThis international qualitative study involved semistructured interviews with patients recovering from abdominal surgery from October 2016 to November 2018 in tertiary hospitals in 4 countries (Canada, Italy, Brazil, and Japan). A purposive maximal variation sampling method was used to ensure the recruitment of patients with varying demographic, clinical, and surgical characteristics. Data on race were not collected. Each interview lasted between 1 and 2 hours. Interviews were recorded and then transcribed verbatim. Transcripts were then analyzed using an inductive thematic analysis approach. Data analysis was conducted from July 2019 to September 2019. MAIN OUTCOMES AND MEASURESThe qualitative analysis revealed themes reflecting the meaning of recovery from the perspective of patients undergoing abdominal surgery.RESULTS Thirty patients recovering from abdominal surgery were interviewed (15 [50%] female; mean [SD] age, 57 [18] years; 10 [33%] underwent major surgery; 16 [53%] underwent laparoscopic surgery). The interviews revealed that for patients undergoing abdominal surgery, the meaning of recovery embodied 5 overarching themes: (1) returning to habits and routines, (2) resolution of symptoms, (3) overcoming mental strains, (4) regaining independence, and (5) enjoying life. Themes associating the meaning of recovery to traditional parameters, such as earlier hospital discharge or absence of complications, were not identified in the interviews.CONCLUSIONS AND RELEVANCE This qualitative study suggests that the meaning of recovery from the perspective of patients undergoing abdominal surgery goes beyond traditional clinical parameters. The elements of recovery identified in this study should be taken into account in patient-surgeon discussions about recovery and when developing patient-centered strategies to improve postoperative outcomes.

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The POSSUM System of Surgical Audit

Cited by 204 publications

References 17 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

Understanding the Meaning of Recovery to Patients Undergoing Abdominal Surgery

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