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Eur J Cardiothorac Surg 2001;19:924-928
© 2001 Elsevier Science NL

Internal comparative audit in a thoracic surgery unit using the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM)

^a Department of Thoracic Surgery, University Of Ancona, Ancona, Italy
^b Department of Epidemiology, Biostatistics and Medical Information Technology, University Of Ancona, Ancona, Italy

Received 26 September 2000; received in revised form 17 January 2001; accepted 15 March 2001.

Corresponding author. Via St. Margherita 23, Ancona 60129, Italy. Tel.: +39-071-34738; fax: +39-071-883911
e-mail: alexit_2000{at}yahoo.com

Objective: The aim of the study was to use the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) to assess the performance of our thoracic surgery unit during two successive periods of activity. Methods: From 1992 through 1997, 801 candidates for thoracic procedures at our institution were considered for the study. After validation of the logistic regression model, including the POSSUM score, observed and POSSUM-predicted morbidities were compared within two groups of patients divided by year of operation (group 1: 1992–1994, n=362; group 2: 1995–1997, n=439) by means of the z-test for the comparison of a proportion with an expected value. Results: The POSSUM-predicted morbidity was significantly lower than the observed one in the first period of activity of our unit (19.6 vs. 24.3%, respectively; z-test for the comparison of a proportion with an expected value, 2.25; P=0.01), whereas no difference was found in the second period (20.5 vs. 19.1%, respectively; z-test for the comparison of a proportion with an expected value, -0.71; P=0.76). Conclusions: The result suggests a worse-than-expected performance of our unit in the first period of activity, showing that POSSUM can be reliably applied as an instrument of internal comparative audit in a thoracic surgery unit.

Key Words: Scoring system • Audit • Morbidity • Thoracic surgery

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