Comparison of Surgical Risk Score, POSSUM and p-POSSUM in higher-risk surgical patients

Br J Surg. 2005 Oct;92(10):1288-92. doi: 10.1002/bjs.5058.


Background: Much current interest is focused on the use of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and the Portsmouth predictor equation (p-POSSUM) for risk-adjusted surgical audit. The Surgical Risk Score (SRS) has been shown to offer an equivalent accuracy, but was validated using a cohort that contained a high proportion of low-risk patients. The aim of this study was to compare the accuracy of mortality prediction using SRS with that of POSSUM and p-POSSUM in a cohort of higher-risk patients.

Methods: Some 949 consecutive patients undergoing inpatient surgical procedures in a district general hospital under the care of a single surgeon were analysed.

Results: The observed 30-day mortality rate was 8.4 per cent. Mean mortality rates predicted using SRS, POSSUM and p-POSSUM scores were 5.9, 12.6 and 7.3 per cent respectively. No significant difference was observed in the area under the receiver-operator characteristic curves for the three methods.

Conclusion: The SRS accurately predicted mortality in higher-risk surgical patients. The accuracy of prediction equalled that of POSSUM and p-POSSUM.

Publication types

  • Comparative Study
  • Validation Study

MeSH terms

  • Hospital Mortality
  • Humans
  • Medical Audit
  • ROC Curve
  • Risk Assessment / methods
  • Sensitivity and Specificity
  • Severity of Illness Index*
  • Surgical Procedures, Operative / mortality*