Comparison of individual urologists' performance

Objective: in the last few yea rs, comparative outcome quality statistics h ave been one of the key topics for discussion in health care. Comparative a udits using overall mortality and morbidity figures can be misleading as th ey do not take into account variations in urological procedure and patient fitness. The purpose of our study was to compare the crude operative morbid ity and mortality rates with the predicted rates using an established scori ng system (POSSUM). Materials and Methods: To examine these effects, we compared 5 urological o perations (transurethral resection of the prostate, transurethral resection of the bladder, radical nephrectomy, suprapubic enucleation of the prostat e and radical prostatovesiculectomy) performed by 2 urologists in a prospec tive study during a 12-month period. POSSUM consists of a simple preoperati ve physiological score, a postoperative score and defined kinds of complica tions. Results: One urologist operated on 160 patients, with an operative mortalit y of 2.5% and morbidity of 31.3%. The other urologist operated on 144 patie nts, with an operative mortality of 0.7% and morbidity of 9%. At first sigh t, there appear to be significant differences in operative outcome between the 2 urologists. However, analysis using the POSSUM system predicts a mort ality rate of 3.1% for the first urologist and 0.7% for the second urologis t (morbidity rates of 35% for the first urologist and 10.4% for the second urologist). Receiver operating curve analysis demonstrated no significant d ifference between the 2 urologists. Conclusion: The present study demonstrates how misleading cru de mortality a nd morbidity figures can be when comparing different urologists. By produ cing a single assessment of physiological status at the time of operation a nd of operative severity, POSSUM analysis allows a more realistic compariso n between different urologists. Copyright (C) 2001 S. Karger AG. Basel.