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

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  2. Dr Alberto Lopes
  3. Professor Richard Edmondson
Author(s)Das N, Talaat AS, Lopes AD, Godfrey KA, Hatem MH, Edmondson RJ, Naik R
Publication type Article
JournalEuropean Journal of Surgical Oncology
ISSN (print)0748-7983
ISSN (electronic)1532-2157
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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.
PublisherWB Saunders Co. Ltd.
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