Risk?adjusted Surgical Audit?Using POSSUM System in Urological Surgery

[[abstract]]Comparative surgical audit by using crude mortality and morbidity rate can be misleading. A risk-adjusted scoring system that aim to compare the surgical outcome between surgeons and hospitals is urgently required. The purpose of this study is using the POSSUM ( Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) scoring system to compare outcomes among physicians. Using logistic regression analysis 2 models were considered in which the dependent variable was the morbidity and the independent variables included the patient factor? surgeon character and operative character.. This is an outcome research. From January 2003 to March 2004 we retrospectively evaluated the surgical outcome of 427 urological patients treated in a medical center located at middle Taiwan . Secondary data was collected from medical records. These patients were admitted for endoscopic surgery (Transurethral resection of prostate and percutaneous nephrolithotomy) and laparatomy surgery( upper urinary surgery, radical prostatectomy and radical cystectomy). The results were: 1.POSSUM score is rapid and easy to use and was applicable in Taiwan. The risk-adjusted outcomes (calculated from POSSUM observed: expected ratios) could offer better comparison between different surgeons than crude morbidity rate did. 2.POSSUM operative severity scores and subspecialty certification were significantly predictive of the postoperative morbidity. But the patient?s age?gender? POSSUM physiological score? seniority had no significant relation on morbidity. Continuous quality improvement is the goal of surgical audit, from our results we suggest : 1.Using evidence-based medicine to evaluate the indication of operation. 2.The hospital should continue evaluate the performance of different surgeons and departments at different time. And also look over the training of medical staff?the specialization program and the privilege of physician periodically. 3.The Bureau of national health insurance could use the POSSUM scoring system to monitor continuously the performance of individual surgeons and individual hospitals. Through this action of continuous quality improvement program we can improve the quality of care