title: Importance of surgical audit: postop complication of gastric cancer surgery among different units.
abstract: OBJECTIVE
  Comparative surgical audit is a very important issue in surgical practice. The POSSUM (Physiological and Operative Severity Score for the enumeration of Morbidity and mortality) system has been proposed as the most efficient risk adjusting tool which can be used to compare surgical outcome among different units. POSSUM was applied for risk-adjusted auditing of different units in a single hospital.
  
  
  METHODS
  In total, 357 gastric cancer patients who underwent radical resection or palliative procedures were analyzed retrospectively to evaluate predictive value of POSSUM scoring system and postop morbidity was compared among 5 different units in a single hospital.
  
  
  RESULTS
  POSSUM predicted well by correct analysis; the observed to expected morbidity ratio (O:E ratio) was 1.01 for patients overall. But there were significant differences in complication rates among different units, the O: E ratio ranging from 0.7-1.63.
  
  
  CONCLUSIONS
  POSSUM is a credible tool for predicting postop morbidity in gastric surgery. It provides risk-adjusted morbidity which can be compared directly. There was surprising difference in surgical outcome among different units of a single hospital, this demands more prospective researches to evaluate surgical outcome of different units. We conclude gastric cancer surgery should be performed in specialized centers.
authors.affiliation: Department of General Surgery, Rui Jin Hospital, Shanghai Jiao Tong University, School of Medicine Shanghai Institute of Digestive Surgery, Shanghai, China. byahut@hotmail.com
authors.forename: Birendra Kumar
authors.initials: BK
authors.lastname: Sah
authors.forename: Zhu Zheng
authors.initials: ZZ
authors.lastname: Gang
authors.forename: Yan
authors.initials: Y
authors.lastname: Min
mesh_terms: D005260:Female; D006757:Hospital Units; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*