Comparison of P-POSSUM risk-adjusted mortality rates after surgery between patients in the USA and the UK
Article first published online: 11 SEP 2003
Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
British Journal of Surgery
Volume 90, Issue 12, pages 1593–1598, December 2003
How to Cite
Bennett-Guerrero, E., Hyam, J. A., Shaefi, S., Prytherch, D. R., Sutton, G. L., Weaver, P. C., Mythen, M. G., Grocott, M. P. and Parides, M. K. (2003), Comparison of P-POSSUM risk-adjusted mortality rates after surgery between patients in the USA and the UK. Br J Surg, 90: 1593–1598. doi: 10.1002/bjs.4347
- Issue published online: 18 NOV 2003
- Article first published online: 11 SEP 2003
- Manuscript Accepted: 30 MAY 2003
The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) criteria have been used to assess surgical risk in patients in the UK. The aim was to determine how applicable these criteria are to patients undergoing surgery in the USA.
Two cohorts of patients undergoing major non-cardiac surgery were followed prospectively in the USA (n = 1056) and the UK (n = 1539). Each patient was assigned a risk score for preoperative physiological status and operative severity using the established POSSUM criteria. Death in hospital was the primary outcome measure. For each patient a predicted risk of death was calculated from Portsmouth POSSUM (P-POSSUM) methodology using an established equation. The relationships between predicted and observed mortality rates in each cohort were investigated by means of multivariate logistic regression.
Within each cohort, an increase in risk estimated by P-POSSUM predicted an increase in observed mortality rate (P < 0·001). For any given risk level, however, mortality rates were significantly higher in the UK cohort than in the US cohort (odds ratio 4·50 (95 per cent confidence interval 2·81 to 7·19); Z = 6·25, P < 0·001).
An increase in predicted risk, based on the P-POSSUM methodology, was associated with a higher mortality rate in patients from both countries. However, risk-adjusted mortality rates following major surgery were four times higher in the UK cohort. These marked differences warrant validation in a larger number of centres. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.