Audit of morbidity and mortality following neck of femur fracture using the POSSUM scoring system.
OBJECTIVE
The aims of this study were to compare the morbidity and mortality data for patients undergoing surgical fixation of a fractured neck of femur (during a 6-month period) to the predicted morbidity and mortality rates obtained from the POSSUM (Physiological and Operative Severity Score for the enUmeration of Morbidity and Mortality) scoring system, adapted for orthopaedic patients. The predictive accuracy of the orthopaedic POSSUM system is evaluated for this population. The 1-year mortality for the males and females of the study group (mean ages) is compared to the 1-year mortality of male and female New Zealanders of the same age.


METHODS
Physiological and operative data was collected from patient notes; patient morbidity and mortality were obtained at 30 days and at 1 year postoperatively. The data were analysed with the orthopaedic POSSUM scoring system.


RESULTS
225 complete datasets were obtained. The mean age of the patients was 83 years; 75% were female. The observed 30-day morbidity and mortality rates were 58% and 12% respectively. The observed 1-year mortality was 38% for males (mean age 79 years) and 29% for females (mean age 84 years). New Zealand census data predicts 7% and 6.4% mortality respectively based on these mean ages.


CONCLUSIONS
The POSSUM system allocates patients into groups of varying risk. The observed data shows higher numbers of complications, including death, in patients allocated into higher risk groups. The 1-year mortality is much higher than that predicted based on mean patient age from the New Zealand abridged life table.
Young
William
W
Department of Anaesthesia, Christchurch Hospital, Christchurch, New Zealand. wyoung@doctors.org.uk
Seigne
Richard
R
Bright
Shona
S
Gardner
Marysha
M
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005265:Femoral Neck Fractures / Q000145:classification* / Q000401:mortality* / Q000601:surgery; D006801:Humans; D008297:Male; D008485:Medical Audit; D009520:New Zealand / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis