Comparison of P-POSSUM risk-adjusted mortality rates after surgery between patients in the USA and the UK

E. Bennett-Guerrero, J. A. Hyam, S. Shaefi, D. R. Prytherch, G. L. Sutton, P. C. Weaver, M. G. Mythen, M. P. Grocott, Michael K. Parides

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Abstract

Background: The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) criteria have been used to assess surgical risk in patients in the UK. The aim was to determine how applicable these criteria are to patients undergoing surgery in the USA. Methods: Two cohorts of patients undergoing major non-cardiac surgery were followed prospectively in the USA (n = 1056) and the UK (n = 1539). Each patient was assigned a risk score for preoperative physiological status and operative severity using the established POSSUM criteria. Death in hospital was the primary outcome measure. For each patient a predicted risk of death was calculated from Portsmouth POSSUM (P-POSSUM) methodology using an established equation. The relationships between predicted and observed mortality rates in each cohort were investigated by means of multivariate logistic regression. Results: Within each cohort, an increase in risk estimated by P-POSSUM predicted an increase in observed mortality rate (P < 0.001). For any given risk level, however, mortality rates were significantly higher in the UK cohort than in the US cohort (odds ratio 4.50 (95 per cent confidence interval 2.81 to 7.19); Z = 6.25, P < 0.001). Conclusion: An increase in predicted risk, based on the P-POSSUM methodology, was associated with a higher mortality rate in patients from both countries. However, risk-adjusted mortality rates following major surgery were four times higher in the UK cohort. These marked differences warrant validation in a larger number of centres.

Original languageEnglish (US)
Pages (from-to)1593-1598
Number of pages6
JournalBritish Journal of Surgery
Volume90
Issue number12
DOIs
StatePublished - Dec 1 2003
Externally publishedYes

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Mortality
Logistic Models
Odds Ratio
Outcome Assessment (Health Care)
Confidence Intervals
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Bennett-Guerrero, E., Hyam, J. A., Shaefi, S., Prytherch, D. R., Sutton, G. L., Weaver, P. C., ... Parides, M. K. (2003). Comparison of P-POSSUM risk-adjusted mortality rates after surgery between patients in the USA and the UK. British Journal of Surgery, 90(12), 1593-1598. https://doi.org/10.1002/bjs.4347

Comparison of P-POSSUM risk-adjusted mortality rates after surgery between patients in the USA and the UK. / Bennett-Guerrero, E.; Hyam, J. A.; Shaefi, S.; Prytherch, D. R.; Sutton, G. L.; Weaver, P. C.; Mythen, M. G.; Grocott, M. P.; Parides, Michael K.

In: British Journal of Surgery, Vol. 90, No. 12, 01.12.2003, p. 1593-1598.

Research output: Contribution to journalArticle

Bennett-Guerrero, E, Hyam, JA, Shaefi, S, Prytherch, DR, Sutton, GL, Weaver, PC, Mythen, MG, Grocott, MP & Parides, MK 2003, 'Comparison of P-POSSUM risk-adjusted mortality rates after surgery between patients in the USA and the UK', British Journal of Surgery, vol. 90, no. 12, pp. 1593-1598. https://doi.org/10.1002/bjs.4347
Bennett-Guerrero E, Hyam JA, Shaefi S, Prytherch DR, Sutton GL, Weaver PC et al. Comparison of P-POSSUM risk-adjusted mortality rates after surgery between patients in the USA and the UK. British Journal of Surgery. 2003 Dec 1;90(12):1593-1598. https://doi.org/10.1002/bjs.4347
Bennett-Guerrero, E. ; Hyam, J. A. ; Shaefi, S. ; Prytherch, D. R. ; Sutton, G. L. ; Weaver, P. C. ; Mythen, M. G. ; Grocott, M. P. ; Parides, Michael K. / Comparison of P-POSSUM risk-adjusted mortality rates after surgery between patients in the USA and the UK. In: British Journal of Surgery. 2003 ; Vol. 90, No. 12. pp. 1593-1598.
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AU - Sutton, G. L.

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