An evaluation of the POSSUM surgical scoring system

POSSUM (Physiological and Operative Severity Score for the enUmeration of Morbidity and mortality) has been studied as a possible surgical audit system for a 9-month interval using a sample of 28 per cent of the general surgical workload, Mortality or survival was analysed as an endpoint. Ira this sample the published POSSUM predictor equation for mortality overpredicted deaths by a factor of more than two, The bulk of the overpredict lon occurred in the group aii lowest risk (predicted mortality 10 per cent Oh less), in which death was overpredicted by a factor of six. This is the most important group for audit purposes since it contains the majority of surgical patients and is composed of fit patients undergoing minor surgery The published predictor equation for mortality returns a minimum predicted mortality of 1.08 per cent, clearly far higher than that expected Tor a fit patient having minor surgery, Logistic regression was done on a set of 1485 surgical episodes to generate a local predictor equation for mortality. This process gave a predictor equation that fitted well with the observed mortality rate and gave a minimum predicted risk of mortality of 0.20 per cent, The previously published POSSUM predictor equation for mortality performed badly when tested using a standard test of goodness of fit for logistic regression and must be modified.