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Understanding Surgical Preparedness and Patient Risk Assessment with POSSUM

Before undergoing surgery, it is crucial to understand patient preparedness, potential risks, and the adequacy of care. This insightful study evaluates 428 orthopedic patients at Karolinska Solna, assessing their individual risks of complications using the POSSUM score. Findings indicate that 65% of patients had over a 20% risk of complications, necessitating intensive care post-surgery. The study highlights the importance of staff competence, necessary resources, and the potential for the POSSUM methodology to inform future care planning and patient outcomes.

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Understanding Surgical Preparedness and Patient Risk Assessment with POSSUM

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Presentation Transcript

  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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