POSSUM for Operative Morbidity and Mortality Risk

Why did you develop the POSSUM? Was there a clinical experience that inspired you to create this tool for clinicians?

I developed it originally to act as an audit aid for the retrospective review of adverse outcomes and then realised that it could be used as a measure of surgeon quality.

Are there any pearls, pitfalls, or tips you have for surgeons using POSSUM to assess operative risk for their patients?

Its main use is in pre-op assessment to give patients and relatives a more realistic expectation of the post-operative course.

Are there cases when it has been applied, interpreted, or used inappropriately?

I have never heard of anyone using it as a 'futility index' (i.e., a reason to avoid a necessary surgery), but that remains a potential risk.

How do you think the POSSUM compares to other similar assessments?

I have looked at the ACS NSQIP risk calculator and have found that, as it depends on surgeon-declared data, it often under-estimates risk, as compared to coded-derived data, which may be a more independent assessment. If these underestimated predictions are communicated to patients, this may cause a future potential problem.

Graham Copeland, MBBS, is a consultant general surgeon at Broadgreen Hospital in Liverpool. Graham has been an advisor to the Healthcare Commission and the National Institute of Clinical Effectiveness in the United Kingdom. Dr. Copeland's research focuses on clinical audits and outcome measures in surgical settings.