Vascular Surgical Society operative outcome study: preoperative physiology predicts outcome

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Abstract
Background: This was an audit of operative outcome conducted by the Vascular Surgical Society of Great Britain and Ireland (VSSGBI). Methods: Some 121 surgeons (all members of the VSSGBI) completed data questionnaires on patients undergoing arterial surgery under their care (mean 12, range 1–49) in May and June 1998. A total of 1480 completed data records were available for logistic regression analysis using the Portsmouth modification of the Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (P-POSSUM) methodology. Information collected included all POSSUM data items plus other factors thought to have a significant bearing on patient outcome: VSSGBI ‘extra items’. The main outcome measures were death within hospital admission and major postoperative complications. The data records were checked for consistency and the remaining 1313 were divided into two sets for analysis. The first ‘training’ set was used to obtain logistic regression models that were applied prospectively to the second ‘test’ data set for various combinations of the POSSUM physiological and operative scores and the VSSGBI ‘extra items’ found to be significantly associated with outcome. Results: Using POSSUM data items alone, it was possible to predict both death and morbidity after vascular reconstruction using P-POSSUM analysis. Addition of the VSSGBI ‘extra items’ found significant in regression analysis did not significantly improve the accuracy of prediction. The most accurate model predicting both death and morbidity was derived from the preoperative physiology components of the POSSUM data items alone. Conclusion: P-POSSUM methodology can be used to predict outcome after arterial surgery across a range of surgeons in different hospitals and could form the basis of a national outcome audit. The most startling finding was that the preoperative physiology scores alone were predictive of both death and major morbidity after vascular reconstruction.

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