Evaluation of Surgical Audit Systems 'POSSUM and P-POSSUM' in Emergency Digestive Surgery

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  • Iwatsuki Masaaki
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University Department of Surgery, National Hospital Organization, Kumamoto Medical Center
  • Haga Yoshio
    Department of Surgery, National Hospital Organization, Kumamoto Medical Center
  • Katafuchi Shigeru
    Department of Surgery, National Hospital Organization, Kumamoto Medical Center
  • Ikei Satoshi
    Department of Surgery, National Hospital Organization, Kumamoto Medical Center
  • Baba Hideo
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University

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  • 消化器外科緊急手術における外科技術評価法Ｐｈｙｓｉｏｌｏｇｉｃａｌ　ａｎｄ　Ｏｐｅｒａｔｉｖｅ　Ｓｅｖｅｒｉｔｙ　Ｓｃｏｒｅ　ｆｏｒ　ｔｈｅ　ｅｎＵｍｅｒａｔｉｏｎ　ｏｆ　Ｍｏｒｔａｌｉｔｙ　ａｎｄ　ｍｏｒｂｉｄｉｔｙ（ＰＯＳＳＵＭ）およびＰ‐ＰＯＳＳＵＭの評価

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Abstract

Background: We evaluated the accuracy of surgical auditing systems, POSSUM and P-POSSUM, developed in the United Kingdom, in emergency digestive surgery. Patients and Methods: Using POSSUM and PPOSSUM, we calculated expected mortality in 294 patients who underwent emergency digestive surgery from January 2001 to December 2003.In the original literature, the endpoint for POSSUM was defined as 30-day mortality and that for P-POSSUM as the in-hospital mortality. The ratio of observed to expected mortality rates (OE ratio) was defined as a measure of accuracy. Results: Overall morbidity was 20.7%, 30-day mortality 6.5%, and in-hospital mortality 7.1%. POSSUM overpredicted mortality rates at a low-risk band where expected rates were 0 to 49%-observed-rate 2/249, 0.80%, vs. expected rate 33/249, 13.3%: OE ratio 0.061 with 95% confidence intervals (CI) of 0.015-0.25. Expected rates were comparable to observed rates at a high-risk band where expected rates were 50 to 100%-observed-rate 17/45, 37.7% vs. expected rate 23/45, 51.1%; the OE ratio 0.74 with 95% CI of 0.46-1.12.Similarly, P-POSSUM overpredicted mortality rates at a low-risk band where expected rates were 0 to 59%-observed rate 6/267, 2.2% vs. expected rate 24/267, 9.0%: OE ratio 0.23 with 95% CI of 0.094-0.58. In contrast, expected rates were closer to the observed rates at a high-risk band where the expected rates were 60 to 100%-observed rate 15/27, 55.6% vs. expected rate 22/27, 81.5%: OE ratio 0.68 with 95% CI of 0.47-1.00.Conclusion: Current single-center data suggests that both POSSUM and P-POSSUM may overpredict mortality rates in low-risk patients who undergo emergency digestive surgery.

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