Auditing morbidity and mortality in gynaecological surgery

Recent high profile failures in recognising sub-optimal surgery have highlighted the importance of quality assurance in operative care. Structure (e.g. suitable equipment), process (e.g. pre-operative protocol adherence), and outcome (e.g. quality of life) are all important variables to audit. Raw data on outcomes does not take into account case mix and therefore data collection and comparisons of surgical mortality and morbidity are not straightforward. The Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) is a method which scores 12 physiological and six operative variables in order to predict surgical morbidity and mortality. Patients are stratified according to risk, and this allows comparative audit between surgeons, units and procedures. If research validates POSSUM for gynaecological surgery, it will provide an accurate assessment of performance, by comparing observed to expected morbidity and mortality in a ‘Variable Life Adjusted Display’ (VLAD). Early recognition and action on poor performance will help maintain and promote quality in gynaecological surgery.