Patient Scoring Systems: Author's Reply

Abstract

Many rural areas in Ireland, like the United KingI agree with authors that this process should be undertaken on a regular basis in a ‘‘blame-free’’ endom, are remote from large vascular units and have large elderly populations with a high incidence of vironment. In reality, all surgeons should now be trained to deliver the best quality of clinical care, given vascular disease. Non-specialist vascular units can only be justified in these areas provided the results the improved structure of surgical training. It is those same surgeons, trained in tertiary centres under the obtained are on par with larger centres. We are currently evaluating our results of extrasupervision of experts, that now are operating in district hospitals serving a sometimes skewed sample of cranial vascular reconstruction from a similar nonspecialist setting using POSSUM and P-POSSUM as the population. Cook et al. has noted that 14% of patients fell within the high-risk category (>50% morpredictors of outcome. The number of cases performed per year does not necessarily indicate excellence. Nontality predicted) at a district hospital compared with only 8% at a teaching hospital. specialist vascular surgery units, in particular, must be the subjects of regular and transparent audit in So why should a difference in morbidity and mortality outcome still exist among us? The current atorder to justify their existence and the service they give to their local population. tempts by the surgical community to answer such questions seems vital. I recommend that we should P. Brady and W. Joyce identify potentially confounding variables before adopting additional predictive variables. We should also Cavan, Ireland doi:10.1053/ejvs.2001.1505, recognise surgical errors as an important variable, with the potential for improved performance through available online at http://www.idealibrary.com on critical incident reporting. Toni Lerut, President of the European Surgical Association, has stated that ‘‘the quality of surgical training is the single most important References factor in reducing intra-surgeon variation’’. A welltrained and well-supervised trainee should obtain 1 Shuhaiber JH, Hankins M, Robless P, Whitehead SM. POSSUM for the prediction of mortality and morbidity in infra-renal abresults equal to a senior surgeon. dominal aortic aneurysm repair. The Hastings experience. Eur J Vasc Endovasc Surg 2001; 22: 180–182. J. H. Shuhaiber 2 Copeland GP, Jones D, Walters M. POSSUM: a scoring system Chicago, Illinois, U.S.A. for surgical audit. Br J Surg 1991; 82: 408–411. doi:10.1053/ejvs.2001.1515, 3 Amundsen S, Skjaerven R, Trippestad A, Soreide O. Abdominal aortic aneurysms. Is there an association between surgical volume, available online at http://www.idealibrary.com on surgical experience, hospital type and operative mortality. Acta Chir Scand 1990; 156: 323–328.