POSSUM scoring for patients with fractured neck of femur

Background. POSSUM scoring is validated as an audit tool in general and orthopaedic surgery. It is also used for preoperative triage to assess perioperative risk. However its ability to predict mortality in specific surgical subgroups, such as patients with fractured neck of the femur, has not been studied. This study assessed the predictive capability of POSSUM for 30-day mortality after surgery for fractured neck of femur. Methods. A cohort study was conducted in Queen's Medical Centre, Nottingham over a period of nearly 2 yr. Complete data from 1164 patients were analysed to compare the mortality predicted by POSSUM and the observed mortality. POSSUM risk of death was calculated using the original POSSUM equation, with modifications to the operative score appropriate for orthopaedic surgery. Results. POSSUM predicted 181 (15.6%) deaths and the observed mortality was 119 (10.2%). The area under the receiver operating characteristic curve was 0.62, indicating poor performance by the POSSUM equation. Conclusion. POSSUM overpredicts mortality in hip fracture patients. It should be used with caution whether as an audit tool or for preoperative triage.