Measuring morbidity following major surgery

A systematic review of the efficacy of a specific perioperative haemodynamic management strategy was performed to explore the balance between therapeutic benefit and adverse effects. Whilst mortality and length of hospital stay were reduced in the intervention group, pooling of morbidity data for between-group comparisons was limited by the heterogeneity of morbidity reporting between different studies. Classification, criteria and summation of morbidity outcome variables were inconsistent between studies, precluding analyses of pooled data for many types of morbidity. A similar pattern was observed in a second systematic review of randomised controlled trials of perioperative interventions published in high impact surgical journals. The Post-operative Morbidity Survey (POMS), a previously published method of describing short-term postoperative morbidity, lacked validation. The POMS was prospectively collected in 439 patients undergoing elective major surgery in a UK teaching hospital. The prevalence and pattern of morbidity was described and compared with data from a similar study using the POMS in a US institution. The type and severity of surgery was reflected in the frequency and pattern of POMS defined postoperative morbidity. In the UK institution, many patients remained in hospital without morbidity as defined by the POMS, in contrast to the US institution, where very few patients remained in hospital in the absence of POMS defined morbidity. The POMS may have utility as a tool for recording bed occupancy and for modelling bed utilization. Inter-rater reliability was adequate and a priori hypotheses that the POMS would discriminate between patients with known measures of morbidity risk, and predict length of stay were generally supported through observation of data trends. The POMS was a valid descriptor of short-term post-operative morbidity in major surgical patients