COMPARISON OF INDIVIDUAL SURGEONS PERFORMANCE - RISK-ADJUSTED ANALYSIS WITH POSSUM SCORING SYSTEM

Comparison of outcome after colorectal resection among different surge ons is difficult. Crude rates of morbidity and mortality can be mislea ding because such rates make no allowance for differences in case mix and fitness of patients. AIM: The aim of this study was to compare out come among five surgeons by means of the simple, well-validated scorin g system POSSUM for risk-adjusted analysis. METHODS: A total of 438 pa tients were studied prospectively. Each patient underwent colorectal r esection by one of the five surgeons. Demographic details, operative p rocedure, and postoperative course were recorded, and physiologic and operative severity scores were determined. Risk of morbidity and morta lity 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, applica tion of POSSUM to allow risk-adjusted analysis of the data demonstrate d that the incidence of morbidity and mortality predicted by POSSUM ba sed on patients physiologic and operative risks factors was very simil ar to the observed outcome for each surgeon. CONCLUSION: Direct compar ison in individual surgeon's performance based on crude rates of morbi dity and mortality can be misleading. Risk-adjusted analysis allows mo re meaningful comparison.