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What you want to know before starting surgery

What you want to know before starting surgery. How well is the patient prepared for the operation ? Are there any risk for complications ? Can we offer an adequate level of care for the patient ? Do we have the necessary staff competence ?. POSSUM.

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What you want to know before starting surgery

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  1. What you want to know before starting surgery • How well is the patient prepared for the operation ? • Are there any risk for complications ? • Can we offer an adequate level of care for the patient ? • Do we have the necessary staff competence ?

  2. POSSUM • =Physiological and Operative Severity Score for enUmeration of Mortality and morbidity • Graham Copeland 1996 • Methodology for assessing clinical performance against the expected outcome for the case-mix • Calculating the risk for every patient as an individual

  3. POSSUM sheet for physiological score POSSUM sheet for operative severity score POSSUM instrument

  4. 3 month prospective pilot study • Orthopedic patients at Karolinska Solna • 428 patients and 485 operations • 27% emergency • Follow up after 30 days

  5. Results

  6. Casemix morbidity

  7. Level of care • 11% of the patients had less than 10% risk ( routine care or daily round by internist?) • 24% of the patients had 10-20% risk ( High Dependency Unit after surgery?) • 65% of the patients had >20% risk ( Intensive Care Unit after surgery?)

  8. Complications per surgeon Odds ratio 1= expected frequency

  9. Results length of stay The mean length of stay for patients with • <10% risk score was 7 days • 10-20% risk score was 19 days • >20% risk score was 11 days

  10. Conclusion POSSUM • can predict complications well and also give a good idea of casemix • can be useful to plan future level of care • can deliver constructive information of the staff competence • information regarding length of stay needs to be further evaluated

  11. Thanks for listening Special thanks to : Carl Aulin Per Svedmark Lars Weidenhielm Lennart Adamsson and Stockholm County Council Ann Fjellner

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