Mohamed et al used the POSSUM score of Copeland et al to audit orthopedic surgery. The authors are from Warrington Hospital in England.


The POSSUM point assignment, morbidity assessment and mortality estimation are those of the original score (above).


Differences from POSSUM score:

(1) peritoneal soiling is replaced by surgical site contamination

(2) operative procedures involves the number done within 30 days

(3) complications (page 736) include unanticipated displacement of a joint implant

(4) warfarin is included as a cardiac sign

(5) timing of operation was elective, urgent or emergency


In the implementation the same assumption was made about the use of the chest X-ray findings (only 1 value for clinical heart failure and X-ray signs of heart failure; only 1 score for respiratory symptoms and X-ray lung findings).


Very major orthopedic surgery (from Table II, page 737):

(1) radical tumor resection

(2) hindquarter or forequarter amputation

(3) major spinal reconstruction

(4) revision of a prosthetic joint in a major joint


Major orthopedic surgery:

(1) amputation of a limb

(2) major joint replacement

(3) arthrodesis of a major joint

(4) ligamentous reconstruction with prosthesis

(5) osteotomy of a long bone

(6) open reduction for a fracture involving a large bone

(7) intervertebral disc surgery (non-laparoscopic)


Intermediate orthopedic surgery:

(1) minor joint replacement

(2) amputation of one or more digits

(3) removal of a small bone

(4) closed reduction of a fracture with external fixation

(5) open reduction for a fracture of a small bone


Minor surgery:

(1) ganglion or bursa removal

(2) fasciotomy

(3) arthroscopic surgery

(4) carpal tunnel surgery or release of entrapped nerve

(5) closed reduction of a fracture

(6) removal of metal

(7) tendon repair


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