Comparison of individual surgeon's performance. Risk-adjusted analysis with POSSUM scoring system

Abstract

Comparison of outcome after colorectal resection among different surgeons is difficult. Crude rates of morbidity and mortality can be misleading because such rates make no allowance for differences in case mix and fitness of patients.

Aim: The aim of this study was to compare outcome among five surgeons by means of the simple, well-validated scoring system POSSUM for risk-adjusted analysis.

Methods: A total of 438 patients were studied prospectively. Each patient underwent colorectal resection by one of the five surgeons. Demographic details, operative procedure, and postoperative course were recorded, and physiologic and operative severity scores were determined. Risk of morbidity and mortality was calculated for each patient.

Results: Incidence of morbidity varied sharply among the five surgeons, from 13.6 to 30.6 percent, and the 30-day mortality varied from 4.5 to 6.9 percent. However, application of POSSUM to allow risk-adjusted analysis of the data demonstrated that the incidence of morbidity and mortality predicted by POSSUM based on patients physiologic and operative risks factors was very similar to the observed outcome for each surgeon.

Conclusion: Direct comparison of individual surgeon's performance based on crude rates of morbidity and mortality can be misleading. Risk-adjusted analysis allows more meaningful comparison.