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Risk adjusted surgical audit in gynaecological oncology: P-POSSUM does not predict outcome

Lookup NU author(s): Dr Alberto Lopes, Professor Richard Edmondson

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Abstract

Aims: To assess the Physiological and Operative Severity Score for the enumeration of mortality and morbidity (POSSUM) and its validity for use in gynaecological oncology surgery. Methods: All patients undergoing gynaecological oncology surgery at the Northern Gynaecological Oncology Centre (NGOC) Gateshead, UK over a period of 12 months (2002–2003) were assessed prospectively. Mortality and morbidity predictions using the Portsmouth modification of the POSSUM algorithm (P-POSSUM) were compared to the actual outcomes. Performance of the model was also evaluated using the Hosmer and Lemeshow Chi square statistic (testing the goodness of fit). Results: During this period 468 patients were assessed. The P-POSSUM appeared to over predict mortality rates for our patients. It predicted a 7% mortality rate for our patients compared to an observed rate of 2% (35 predicted deaths in comparison to 10 observed deaths), a difference that was statistically significant (H&L χ2 = 542.9, d.f. 8, p < 0.05). Conclusion: The P-POSSUM algorithm overestimates the risk of mortality for gynaecological oncology patients undergoing surgery. The P-POSSUM algorithm will require further adjustments prior to adoption for gynaecological cancer surgery as a risk adjusted surgical audit tool.

Publication metadata

Author(s): Das N, Talaat AS, Lopes AD, Godfrey KA, Hatem MH, Edmondson RJ, Naik R

Publication type: Article

Publication status: Published

Journal: European Journal of Surgical Oncology

Year: 2006

Volume: 32

Issue: 10

Pages: 1135-1138

ISSN (print): 0748-7983

ISSN (electronic): 1532-2157

Publisher: WB Saunders Co. Ltd.

URL: http://dx.doi.org/10.1016/j.ejso.2006.06.010

DOI: 10.1016/j.ejso.2006.06.010

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