Cirugía Española

Cirugía Española

Volume 80, Issue 6, December 2006, Pages 395-399
Cirugía Española

Originales
Sistema POSSUM. Un instrumento de medida de la calidad en el paciente quirúrgicoThe possum scoring system: an instrument for measuring quality in surgical patients

https://doi.org/10.1016/S0009-739X(06)70993-9Get rights and content

Resumen

Introducción

La escala POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) es un sistema de clasificación de pacientes que se utiliza para predecir la mortalidad y la morbilidad ajustada a riesgo en gran variedad de procesos quirúrgicos. El objetivo de este trabajo es valorar su utilidad en los pacientes quirúrgicos de un servicio de cirugía general.

Pacientes y métodos

La escala se ha aplicado, de forma prospectiva, a los pacientes intervenidos por laparotomía programada y urgente en nuestro departamento de cirugía general (hospital nivel II) durante un período de 8 meses. Se han incluido 105 casos de los que 81 fueron operados de forma programada y los 24 restantes, de forma urgente. Posteriormente, se han comparado, utilizando el test exacto de Fisher, los resultados predichos por la escala con los observados en la realidad.

Resultados

La puntuación fisiológica media fue de 23,4 puntos (rango: 12-40 puntos), y la quirúrgica de 11,3 puntos (rango: 6-24 puntos). Fallecieron 3 pacientes y 47 presentaron morbilidad. Al comparar los resultados observados con los predichos por el sistema POSSUM, en cuanto a mortalidad, no se hallaron diferencias significativas en el análisis por grupos de riesgo, excepto en el grupo de riesgo < 20%, en el que el POSSUM sobreestimó la mortalidad. En cuanto a la morbilidad, el POSSUM la infravaloró para el grupo de riesgo < 20%.

Conclusión

El sistema POSSUM es una herramienta útil para los análisis de morbimortalidad en nuestros pacientes quirúrgicos.

Introduction

The POSSUM scale (Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) is a scoring system that is used to predict risk-adjusted mortality and morbidity rates in a wide variety of surgical procedures. In this prospective study, the validity of the POSSUM scale was evaluated in patients undergoing laparotomy in a general surgery department.

Patients and methods

The POSSUM scale was prospectively applied in all patients undergoing elective and emergency laparotomy in the general surgery department of a level II hospital over 8 months. A total of 105 patients were included, of which 24 underwent emergency laparotomy and 81 underwent elective surgery. Predicted mortality and morbidity rates were calculated by using the POSSUM scale. These results were compared with actual outcomes by using Fisher’s test.

Results

The mean physiological score was 23.4 points (range: 12-40 points), while the mean surgical score was 11.3 points (range: 6-24 points). Three patients died during the postoperative period and 47 had morbidity. When the observed results for mortality were compared with those predicted by the POSSUM scoring system, no significant differences were observed in the analysis by risk groups, except in the risk group < 20 %, in which the POSSUM scale overestimated mortality. The risk of morbidity was underestimated by the POSSUM scale in the risk group < 20 %.

Conclusion

The POSSUM scoring system is a useful predictor of morbidity and mortality in patients undergoing emergency and elective laparotomy.

Bibliografía (20)

  • R.S. Mohil et al.

    POSSUM and P-POSSUM for risk-adjusted audit of patients undergoing emergency laparotomy

    Br J Surg

    (2004)
  • G. Copeland

    The POSSUM System of Surgical Audit

    Arch Surg

    (2002)
  • L. Fernández Fernández et al.

    Valoración de la calidad asistencial quirúrgica mediante el sistema POSSUM

    Cir Esp

    (1998)
  • P.P. Tekkis et al.

    Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM)

    Br J Surg

    (2004)
  • D.R. Jones et al.

    Comparison of POSSUM with APACHE II for prediction of outcome from surgical high-dependency unit

    Br J Surg

    (1992)
  • G.P. Copeland et al.

    POSSUM: a scoring system for surgical audit

    Br J Surg

    (1991)
  • G.P. Copeland

    Assessing the surgeon: 10 years’ experience with the POSSUM system

    J Clin Excellence

    (2000)
  • G.P. Copeland

    Comparative audit: fact versus fantasy

    Br J Surg

    (1993)
  • W.A. Knaus et al.

    APACHE II: a severity of disease classification system

    Crit Care Med

    (1985)
  • M.S. Whiteley et al.

    An evaluation of the POSSUM surgical scoring system

    Br J Surg

    (1996)
There are more references available in the full text version of this article.

Cited by (23)

  • P-POSSUM as mortality predictor in COVID-19-infected patients submitted to emergency digestive surgery. A retrospective cohort study

    2021, International Journal of Surgery
    Citation Excerpt :

    However, raw mortality rate is difficult to evaluate without adequate risk stratification. Different predictive scores for surgical risk have been designed to assign an adjusted risk of postoperative complications and/or mortality in surgical patients [1–6]. These scores can help to identify “high risk” patients who could benefit from intensified peri- and postoperative care, including early postoperative admission in ICU units or even referral to other centers [3].

  • Perioperative complications following bariatric surgery according to the clavien-dindo classification. Score validation, literature review and results in a single-centre series

    2017, Surgery for Obesity and Related Diseases
    Citation Excerpt :

    The validation process consists of determining whether the instrument we are using “really measures what it has to measure.” As the validation process follows some very specifically established steps, it should be applied obligatorily in all studies of this type [27]. The first step is to translate the scale, in the event that it has been originally described in a language different to one’s own.

  • High-risk surgery: Epidemiology and outcomes

    2011, Anesthesia and Analgesia
    Citation Excerpt :

    The Surgical Risk Score,40 and the later modification of it by Donati et al.,41 are based on the ASA-PS system, but also include details of the proposed surgical procedure; both systems demonstrate improved predictive accuracy compared with the ASA-PS system used alone. However, caution should be exerted when considering the use of any of these models for clinical decision making on whether to proceed with a proposed intervention, because they demonstrate variable predictive precision, particularly at the extremes of age42,43 and calculated risk.44–46 Furthermore, although a direct comparison of risk stratification models revealed POSSUM to be superior to ASA-PS and Charlson for the prediction of 30-day morbidity, none of these systems was an accurate predictor of 90-day mortality.47

View all citing articles on Scopus
View full text