title: Risk-adjusted scoring systems can predict surgeons' performance in colorectal surgery.
abstract: BACKGROUND
  the physiological & Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) was derived from a heterogeneous general population and has been used successfully as an audit tool to provide risk-adjusted operative mortality rate. The aim of this study was to investigate whether risk-adjusted scoring systems can accurately predict outcomes of colorectal operations done by colorectal and non-colorectal surgeons.
  
  
  METHODS
  the study was conducted prospectively on 899 consecutive patients who underwent major elective and emergency colorectal procedures over three years between 2002 and 2004 at University Hospital Coventry and Warwickshire. The outcome parameter was defined as 30-day mortality. The observed mortality was then compared to POSSUM-predicted mortality. Hosmer-Lemeshow and Fisher's Exact test were used to assess statistical significance in outcome between non- and coloproctologists.
  
  
  RESULTS
  CR-POSSUM was the most accurate predictive model for outcomes of major colorectal operations between surgeons. The overall mortality rate amongst coloproctologists was 7% (5% elective & 13% emergency), whereas the overall mortality was 17% (3% elective & 21% emergency) in non-coloproctologists.
  
  
  CONCLUSIONS
  CR-POSSUM was the better prediction model than POSSUM. Coloproctologists delivered a significantly lower overall mortality, but not in the emergency setting. However, given the few number of elective colorectal resections performed by non-coloproctologists, more cases are required to permit meaningful comparison for the outcomes of major colorectal operations among different surgeons.
authors.affiliation: Department of Surgery, University Hospitals Coventry and Warwickshire, Coventry, CV2 2DX, UK. ed.leung@doctors.org.uk
authors.forename: Edmund
authors.initials: E
authors.lastname: Leung
authors.forename: Ali M
authors.initials: AM
authors.lastname: Ferjani
authors.forename: Andrew
authors.initials: A
authors.lastname: Kitchen
authors.forename: Damian
authors.initials: D
authors.lastname: Griffin
authors.forename: Nigel
authors.initials: N
authors.lastname: Stellard
authors.forename: Ling S
authors.initials: LS
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003107:Colorectal Surgery / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020379:Risk Adjustment; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult